Strange Behavior in a Patient with HIV
Morning Report
What’s your differential diagnosis to explain the “strange behavior” of a patient with newly diagnosed HIV/AIDS?
Jaundice and Transaminases >1000
Morning Report
Thank you Shirley for a great presentation on a young patient presenting with jaundice, AST 2552 and ALT >5000!
What’s the differential?
Acute Promyelocytic Leukemia
Morning Report
Thank you Dr. John Hollowed for an excellent presentation on acute promyelocytic leukemia
Teaching Points
- APL accounts for 5-20% of AML cases
- Increased incidence in people with prior cytotoxic therapy
- Presents with complications of pancytopenia, weakness, fatigue, infections, increased bruising/bleeding, DIC
- Diagnosis: bone marrow analysis and confirmation with PCR, FISH, or cytogenic analysis
- Treatment is All-trans Retinoic Acid (ATRA)
Huntington’s Disease
Morning Report
Thank you Dr. Liza Buchbinder for an excellent presentation on Huntington’s Disease
Teaching Points
- Etiology: Autosomal dominant; Drug induced (antipsychotics, estrogen containing); Endocrine (thyrotoxicosis, hyperglycemia); pregnancy (chorea gravidarum); streptococcal infection (Sydenham chorea); autoimmune (SLE, APLS); neurodegenerative d/o of basal ganglia.
- Associated w/ parkinsonism, impulsiveness, psychiatric disorders, and dementia.
- Treatment is symptomatic
TCA Induced Cardiotoxicity
Morning Report
Thank you Dr. Daniel Jimenez for an excellent presentation on TCA induced cardiotoxicity Teaching Points Clinical presentation: anticholinergic sx (urinary retention, constipation), CNS (seizures, coma), acidosis, arrythmias ECG: prolonged QRS/PR/QT --> predisposes for ventricular arrhythmias) Management: supportive care, benzos for seizures,…
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
Disseminated Histoplasmosis
Morning Report
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
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
Acute Esophageal Variceal Bleed
Morning Report
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
Pulmonary Squamous Cell Carcinoma
Morning Report
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%)