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

Archive of Didactics in Morning Report

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

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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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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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