Monthly Archives: September 2016

Multiple Myeloma

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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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Gastrointestinal Stromal Tumor

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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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Fever of Unknown Origin and Giant Cell Arteritis

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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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Updated Remote ORCHID Access… MAC Users Included

If you are as yet unable to connect to ORCHID remotely, this update is for you.

You can now connect to ORCHID through VDI (virtual desktop infrastructure), and this will work for PC and MAC users alike.  Simply follow the attached instructions: DHS VDI for External Users.  They will guide you to download and install VMWare for your operating system, and then you can log-in via the new link: https://myremotepc.dhs.lacounty.gov

Some notes:

  • If you previously installed another version of VMWare, you may need to uninstall the old version and install the new one.
  • The Virtual Desktop includes access to workstation applications like Synapse.
  • Protect all health information! You should not allow others to access health information or leave your workstation or mobile device unattended or insecure.

Hemophagocytic Lymphohistiocytosis

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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Dressler’s Syndrome

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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FALL RETREAT !!!!!!!!!

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When: Friday, Sept 9th; arrive by 9:30am at Memorial Park Levitt Pavillion.

The theme for our retreat is “ the Amazing Race through Residency”

Wear comfortable clothes and shoes.  bring a bottle of water and sunscreen

Address:  85 East Holly Street, Pasadena, CA 91103

The team list is attached below

Parking :  Please the attachment below .

Lunch:  After our race, we will have a wrap up session,lunch, meeting and feedback session at Cafe Santorini from 12:30-4pm.

Happy Hour with The Chiefs after 4 pm in Pasadena

Goals:

The goals for the  Fall retreat are to promote teamwork and for all of us to get to know each other better while giving you an opportunity to get important updates and give feedback !!!!We are looking forward to a great bonding experience while we discover more about our neighboring city and each other.

2016-fall-retreat_parking-options

ovmc-fall-retreat-2016-team-list