Thanks to Dr. Hsieh for an excellent morning report on Lung Abscesses

Learning Points:
— Risk factors for developing lung abscesses: peridontal disease, dysphagia, diminished gag or cough reflex, ETOH abuse and seizure disorder
— Common anaerobes: Peptostreptococcus species, Bacteroides species, Fusobacterium species and microaerophilic streptococci
— Common aerobes: Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae (rarely), Klebsiella pneumoniae, Haemophilus influenzae, Actinomyces species, Nocardia species, and Gram-negative bacilli.

Check out this great Medscape article by our own Dr. Jason Bahk and Dr. Nader Kamangar

Thank you Dr. Sue Zhang for a great morning report on a patient with Cushing’s disease!

Learning points:
-Consider screening for hypercortisolism in a patient with hypokalemia, metabolic alkalosis, and hypertension
-Etiologies for Cushing’s Syndrome include 1) Cushing’s Disease (pituitary) 2) Ectopic ACTH-secreting tumor 3)Primary adrenal neoplasm
-In a patient with both hypokalemia and hyperglycemia, make sure to aggressively replete potassium before administering insulin.
—Cushing’s syndrome review article: A thorough review of the epidemiology, workup, etiology, and management of Cushing’s syndrome

Thanks to Caleb Hsieh for an excellent morning report!

Learning Points:
-Common causes of rhabdomyolysis include muscle trauma or crush injury, extreme exertion, drugs and toxins.
-The mainstay of treatment of AKI due to rhabdomyolysis is aggressive fluid resuscitation and correction of electrolyte abnormalities.
–Rhabdo Review Article: An excellent review of epidemiology, pathophysiology, and treatment of rhabdo.

Thanks to Nayiri for a great final AM report on atrial fibrillation!

Learning points:
– Etiology of atrial fib = PIRATES (Pulm, Ischemic, Rheumatic heart, Anemia/Atrial myxoma, Thyroid, Ethanol, Sepsis)
– Diamond-Forrester definition of typical angina = (1) substernal, (2) onset w/ exertion or emotional stress, (3) relieved w/ rest or nitrate
– AFFIRM (2002): rate control had equivalent outcomes to rhythm control w/ less adverse events
– RACE II (2010): lenient rate control (HR<110 at rest) as effective as strict (HR<80 at rest)

Thanks to Jason Bahk for a great presentation today!

Today’s learning points:
– Anti-synthetase syndrome: +Anti-synthetase Ab, ILD, inflammatory myopathy, inflammatory polyarthritis
– On exam: fever, “Mechanics’ hands’, non-erosive arthritis, myopathy
– Multiple cardiac manifestations: conduction, CHF, perimyocarditis
– Ddx for rhabdo causes include trauma, overexertion, metabolic, drug/toxin, inflammatory myopathies
– NEJM review on Inflammatory Muscle Diseases

Learning Points:
• Acute limb ischemia is a sudden decrease in limb perfusion that threatens limb viability
• Etiology includes acute thrombosis, embolism from the heart, atherosclerosis, trauma and many more
• Assess the 6P’s: Pain, Pallor, Pulselessness, Parasthesia, Poikilothermia and Paralysis
• PROMPT diagnosis is necessary in an effort to salvage the limb
• Treatment options include anti-coagulation, endovascular revascularization vs surgical revascularization
• For more information, check out this article from NEJM.

Learning points

1) Keep autoimmune hepatitis on your differential for a patient presenting with jaundice and hepatitis.
2) There is a wide spectrum of presentations, from mild asymptomatic AST/ALT elevations to fulminant liver failure.
3) Autoimmune hepatitis is a type of chronic hepatitis, more commonly seen in women of any age, but dx is most commonly in the 40-50 age range.
4) Antibodies commonly associated with the dx: ANA, Anti-Smooth Muscle, Anti-Mitochondrial, Anti-SLA/LP (soluble liver antibody/liver pancreas), and elevated IgG levels.
5) Treatment = Prednisone +/- Azathioprine

Learning points:
1. Kussmaul’s sign refers to a jugular venous pulsation that rises with inspiration and is due to the constriction of pericardium

2. Ventricular interdependence is the classic echo finding of constrictive pericarditis where the volume in the left heart is dependent on the volume in the right heart

3. Constrictive cardiomyopathy often has both systolic and diastolic dysfunction with normal BNP while restrictive cardiomyopathy is pure diastolic dysfunction and elevation of BNP.

4. Click below for a great review from NEJM: