Category Archives: Morning Report
Disseminated Gonococcal Infection – 10/16/17
Epidemiology
- Young (< 40 years old)
- Women (because they are usually asymptomatic)
- 0.5-3% of people infected with N. gonorrheae
- Common cause of acute arthritis in young people
Clinical Manifestations
- 1) triad of tenosynovitis (migratory), dermatitis (painless lesions – usually pustular or vesiculopustular), and polyarthralgias (small or large joints – usually asymmetric)
- 2) purulent arthritis without skin lesions – usually one joint affecting knees, wrist, or ankles
Evaluation
- Clinical suspicion – thorough history of physical
- Blood cultures
- Specimen from mucosal sites – urogenital, rectal, pharyngeal
- Synovial fluid – only positive 50% of the time – NAAT testing better than cultures
Treatment
- Ceftriaxone 7-14 days (can give IM if non-purulent arthritis)
- Remember to co-treat for chlamydia with azithromycin
Multiple Myeloma – 10/10/2017
Acute Bacterial Meningitis – 10/03/2017
Post-Streptococcal Glomerulonephritis
Dysphagia – 09/19/2017
Critical illness myopathy – 9/20/17
Remember – a lot of this diagnosis can be made with labs and a good physical exam!
Steroid induced myopathy – normal CK and normal DTRs
Critical illness myopathy/neuropathy – elevated CK and decreased DTRs
GBS – normal CK and decreased DTRs
Inflammatory myopathy – elevated CK with normal DTRs
If you have a patient who had inflammatory myopathy and was receiving steroids for treatment and despite a normalization in CK did not have improvement in weakness – wean off the steroids because this likely now became a steroid induced myopathy!
Central Retinal Artery Occlusion – 9/18/17
Hypervirulent (Hypermucoviscous) Klebsiella – 09/06/2017 (Presented by guest lecturer Brian Sun, MD)
Calciphylaxis – 9/13/17
This is a RARE entity (only about 5% of ESRD patients) but has a HIGH mortality (60-80% in 1 year!)
Etiology: Abnormal deposition of calcium in the lumen of the arterial vasculature leading to compromised blood flow to the tissues and necrosis
Risk factors: Female sex, autoimmune disease, prednisone or coumadin use, elevated phosphorus levels, obesity, diabetes, and low albumin. Higher risk of development if you have a calcium x phosphorus level > 60-70.
Clinical presentation: Painful subcutaneous nodules with overlying red/brown patches and eventual central necrosis and eschars. Usually located in areas of high adipose tissue (thighs, abdomen, etc)
Treatment: Mostly supportive – have your patients eat a low phosphate diet and use non-calcium containing phosphate binders! (Remember, the calcium containing ones will cause more harm because it will still elevated your calcium x phosphate product!). Studies have shown some benefit to using sodium thiosulfate and hyperbaric oxygen but calciphylaxis cannot be cured.
SCVMC IM Chief Resident Blog 