UTHSCSA Chiefs

UTHSCSA Internal Medicine Residency: Tweeting our morning report clinical pearls

[UTHSCSA Chiefs @uthscsaIMres]

Most common causes of extremely elevated transaminases: ischemic (shock) liver, hepatitis, Tylenol OD

[UTHSCSA Chiefs @uthscsaIMres]

DILI: Drug Induced Liver Injury. Refer to ACG Guidelines [Am J Gastroenterol] for calculation of R value.

[UTHSCSA Chiefs @uthscsaIMres]

Great case of Coccidiomycosis in Morning Report today! Remember serologic tests are specific but not sensitive. #IMConf #MRPearls

[UTHSCSA Chiefs @uthscsaIMres]

Myasthenia treatment: anticholinest., +/- immunosuppresives, +/- IvIG & plasmapheresis if crisis. Thymectomy if thymoma #MRpearls #IMConf

[UTHSCSA Chiefs @uthscsaIMres]

Order CT chest to check for presence of thymoma in pts with myasthenia gravis. 30% also have thyroid disease, check TFTs #MRpearls #IMConf

[UTHSCSA Chiefs @uthscsaIMres]

MG Dx confirmed w/ Serum autoAbs(anti-Ach recept, anti-MuSK Ab), neither may be present in ocular MG. +/- EMG/NCS if Abs neg #MRpearls

[UTHSCSA Chiefs @uthscsaIMres]

MG clinical: Ocular(ptosis/double vision), Bulbar(dysphagia/dysarthria), weakness, gait abnl, diaphragm affected in MG crisis #MRpearls

[UTHSCSA Chiefs @uthscsaIMres]

Myasthenia Gravis(MG) clinical: Hallmark- MSK weakness that increases during activity & improves after periods of rest #MRpearls #IMConf

[UTHSCSA Chiefs @uthscsaIMres]

A: Clostridium Perfringens. Correct @carolrami_carol #IMtrivia #IMConf

[UTHSCSA Chiefs @uthscsaIMres]

Q: Intravascular hemolysis 2/2 lytic enzymes from which gram-positive bacteria may cause red cell ghosts on periph smear? #IMtrivia #IMConf

[UTHSCSA Chiefs @uthscsaIMres]

A: Human Herpesvirus 6. Correct @carolrami_carol #IMtrivia #IMConf

[UTHSCSA Chiefs @uthscsaIMres]

Q: Reactivation of which viral infection is classically associated with DRESS syndrome? #IMtrivia #IMConf

[UTHSCSA Chiefs @uthscsaIMres]

DRESS Rx: stop drug, symptomatic relief. Pred 0.5-2mg/kg if severe organ injury, taper over 8-12 wks once labs normalize. #MRpearls #IMConf

[UTHSCSA Chiefs @uthscsaIMres]

DRESS: Classically a/w antiepliptics. ? genetic predispo a/w allopurinol or carbamazepine. Avg onset 2-6 wks after new med #MRpearls #IMConf

[UTHSCSA Chiefs @uthscsaIMres]

DRESS syndrome: morbilliform rash, eosinophilia, fever, LAD, facial edema, liver/kidney/lung involvement #MRpearls #IMConf

[UTHSCSA Chiefs @uthscsaIMres]

Morbilliform rash = measle like. MC type of adv drug rxn. Diffuse, symmetric erythematous macules/papules 1wk after drug #MRpearls #IMConf

[UTHSCSA Chiefs @uthscsaIMres]

A: SLE is a/w shrinking lung syndrome which is SOB, pleuritic CP, and diminishing lung volumes. Correct @carolrami_carol #IMtrivia #IMConf

[UTHSCSA Chiefs @uthscsaIMres]

What rheumatic disease is associated with the shrinking lung syndrome? #IMtrivia #IMConf

[UTHSCSA Chiefs @uthscsaIMres]

A: Paget's Disease. Correct @mazyarmalakouti #IMtrivia #IMConf

[UTHSCSA Chiefs @uthscsaIMres]

Q: What acquired bone disease is often associated with hearing loss? #IMtrivia #IMConf