County of Los AngelesHealth AgencyDept of Health ServicesOlive View-UCLA Medical CenterDept of Medicine

Archive of Didactics

Mar 09 2017

STOPAH TRIAL

EBM, Journal Club

Thank you Quynh Vu for your excellent overview of the STOPAH trial (Prednisolone or Pentoxifylline for Alcoholic Hepatitis) Conclusions of the study: Pentoxifylline did not improve survival in patients with alcoholic hepatitis Prednisolone was associated with a reduction in 28-day…

Clinical Topics:

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Feb 13 2017

Neuropsychiatric Lupus

Morning Report

Excellent morning report today with Thomas Vu on Neuropsychiatric Lupus! Take a look at on the latest review on neuropsychiatric SLE: Management of Neuropsychiatric Systemic Lupus Erythematosus: Current Approaches and Future Perspectives on PubMed

Clinical Topics:

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Feb 01 2017

Disseminated Histoplasmosis

Morning Report

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

Clinical Topics:

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Jan 30 2017

Neurocysticercosis

Morning Report

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

Clinical Topics:

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Jan 25 2017

Acute Esophageal Variceal Bleed

Morning Report

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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

Clinical Topics:

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Oct 28 2016

Pulmonary Squamous Cell Carcinoma

Morning Report

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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%)

Clinical Topics:

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Oct 03 2016

Thyrotoxicosis

Morning Report

Definition:  thyrotoxic 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,…

Clinical Topics:

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Sep 28 2016

Multiple Myeloma

Morning Report

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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Sep 20 2016

Gastrointestinal Stromal Tumor

Morning Report

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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