This is an often missed diagnosis: Common red flags missed are unexplained fever, focal deficits, and active infection
Hospitalist Lecture: Reagan Noon Conference August 3rd, 2018
Thanks for an awesome lecture by one of our core hospitalists (and former chiefs!) Dr. Faysal Saab on Inpatient Hypertension.
Remember, there is new terminology for inpatient hypertension: Hypertensive emergency, Hypertensive Urgency, and Severe Uncontrolled Hypertension. Think hard about the risks and benefits before you treat Severe Uncontrolled Hypertension, it's probably not necessary!
Chief Special: Santa Monica Noon Conference July 23rd and Reagan Noon Conference on July 24th, 2018
Congrats to our winners of the Chief Specials, Team "Mystery Faculty" and "Casey n the Boyz"
Top 5 Pearls from the Cases:
- Post-Streptococcal GN has low C3, normal C4 due to preferential use of the alternative complement pathway
- The shoulder-fat-pad sign is pathognomonic for amyloidosis
- Think of Dengue with retro-orbital pain and the tourniquet sign
- Hyperkalemia is a poor prognostic sign in Acute Digoxin Toxicity. Don't rely on Dig levels!
- Alcohol induced bone pain and lymph node swelling could be a sign of Hodgkin's Lymphoma
Conference Pearls: VA Morning Report on July 19th, 2018
Thanks Rani for a very interesting case (and complete Zebra) presentation on a patient with pancreatitis due to ectopic pancreatic tissue in the stomach! During the case we had the opportunity to review pancreatitis, infectious diseases from Southeast Asia and Latin America, and gastric masses.
A “pancreatic rest” is ectopic pancreatic tissue, found in 2% of patients on autopsy. These have a tendency to become inflamed causing pancreatitis, and have a high likelihood of secondary infection. They are diagnosed on EGD.
Gastric Mass Differential
- GrowthPeptic Ulcer Disease
- Gastric epithelial polyp
- Adenomatous polyp
- Benign stromal tumor (leiomyoma)
- Pancreatic rest
- Menetrier’s Disease (Hypertrophic gastropathy)
- Gastric adenocarcinoma
- Gastric lymphoma (MALToma)
- Gastric carcinoid
- Kaposi Sarcoma
Conference Pearls: Reagan Resident Report on July 16th, 2018
Thanks Michelle for an awesome resident report on a patient presenting with syncope. In a heart stopping (no pun intended) turn of events, the patient had AV block and was later found to have cardiac sarcoid!
- In patients with syncope, think of your three broad categories: Reflex-mediated (most common), Cardiac (including arrhythmia and structural), Orthostasis
- High value workup for syncope: A careful history and exam, orthostatics (immediate and delayed 3-5 minutes), and EKG. Only obtain a TTE if you have suspicion for structural heart defects.
- Diagnose cardiac sarcoid with a cardiac-PET and by ruling out other diseases (sarcoidosis is a diagnosis of exclusion)
- AV block has a very interesting differential.
Slide courtesy of Michelle Chong