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

Archive of Didactics

Sep 19 2016

Fever of Unknown Origin and Giant Cell Arteritis

Morning Report

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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
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Sep 16 2016

Hemophagocytic Lymphohistiocytosis

Morning Report

Teaching Points

  • Definition: severe hyperinflammation caused by uncontrolled proliferation of activated lymphocytes and macrophages
  • Presentation: fever, hepatosplenomegaly, lymphadenopathy, jaundice and a rash.
  • Diagnosis: Fulfillment of five out of the eight criteria below: fever (>100.4 °F, >38 °C), splenomegaly, cytopenias affecting at least two of three lineages, hypertriglyceridemia, ferritin ≥ 500 ng/ml, haemophagocytosis in the bone marrow, spleen or lymph nodes, low or absent natural killer cell activity, soluble CD25
  • Treatment:  high dose corticosteroids, etoposide and cyclosporin
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Sep 14 2016

Dressler’s Syndrome

Morning Report

Thank you Dr. McCutcheon for an excellent case and presentation on Dressler’s Syndrome

Teaching Points

  • Post MI complications: electrical, mechanical, ischemic, shock, pericaditis, post infarction angina
  • Electrical: accelerated idioventricular rhythm, ventricular arrhythmias, bradycardia, heart blocks, intraventricular blocks
  • Mechanical: papillary muscle dysfunction/rupture, ventricular septal rupture, free wall rupture
  • Dressler’s syndrome:  immune mediated pericarditis in response to the damage to heart tissue or to the pericardium, from events such as a heart attack, surgery or traumatic injury
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Aug 23 2016

Tolosa Hunt Syndrome

Morning Report

Teaching Points: Definition: Episodic orbital pain associated with paralysis of one or more of the CN III, IV, VI due to granulomatous inflammation of the cavernous sinus Presents with episodic painful ophthalmoplegia, CNIII, IV, VI Palsy leading to diplopia, usually…

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Aug 08 2016

Drug reaction with eosinophilia and systemic symptoms (DRESS)

Morning Report

OLYMPUS DIGITAL CAMERA

Teaching Points

  • Potentially life-threatening, drug-induced hypersensitivity reaction
  • Presents with fever, malaise, skin eruption, hematologic abnormalities (eosinophilia, atypical lymphocytosis), lymphadenopathy, and internal organ involvement (liver, kidney, lung)
  • Management is withdrawal of offending drug, topical or oral/IV glucocorticoids (if severe disease)
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Jul 20 2016

Management of Cirrhosis – The Basics

Morning Report

cirrhosis-s1-facts

Teaching Point

  • Common etiologies
    • Alcohol
    • Hepatitis C and B
    • NAFLD
  • Complications
    • Ascites: spironolactone 100mg/lasix 40mg
    • SBP: ceftriaxone 2gm IV q24h
    • Hepatic encephalopathy: lactulose, neomycin/rifaximin
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Jul 13 2016

Intern Case Conference – Acute Coronary Syndrome

Morning Report

Here is the powerpoint for today's intern case conference on ACS: InternReport.ACS Guidelines: AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction Further Reading: Mechanisms of ACS and their…

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Jul 12 2016

Drug-Induced Liver Injury

Morning Report

Highlighted_Liver_crop

Thank you Dr. Reynolds for an excellent presentation on drug-induced liver injury

Teaching Points

  • Patterns of abnormal LFTS
    • Hepatocellular: high AST/ALT w/mild elevation in alk phos
    • Cholestatic: High alk phos w/ mild AST/ALT
  • Causes of hepatocellular injurry
    • Alcohol: AST elevation greater than ALT
    • Viral: ALT elevation greater than AST
    • NAFLD/NASH: AST to ALT ratio typically 1
    • Toxins: NSAIDS, abx, statins, anti-epileptic drugs
    • Hereditary/autoimmune: hemochromatosis, autoimmune hepatitis, alpha-1-antitrypsin deficiency, Wilson’s disease
    • Shock: high elevations in AST/ALT
    • Non-hepatic causes: muscle disorders, thyroid issues, celiac disease, adrenal insufficiency, anorexia
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