Differentiating Conversion vs Factitious vs Malingering Disorders – Hughes

Difficulty is that these cannot be differentiated by self-report only; the clinician HAS to investigate other sources of information. CONVERSION Symptoms or deficits affecting voluntary motor or sensory functioning Actually very rare Commonly recurs (25% in the first year) Risk factors:  maladaptive personality traits (borderline, histrionic traits), history of childhood abuse/neglect, stressful life events may… Continue reading Differentiating Conversion vs Factitious vs Malingering Disorders – Hughes

Heparin-Induced Thrombocytopenia – Stuart

HIT occurs in 5% of patients exposed to heparin. Etiology:  Autoantibody to PF4-heparin complex. More common with UFH, in women, and with surgery. Thrombocytopenia is noted in 90%, thrombosis in 50%. Dx:  Lab:  HIT antibody testing:  PF4 antibody, IgG Clinical Dx:  Four T Score: 4 T's score [From UpToDate, 4/21/17]:  Calculating the score — The 4 T's… Continue reading Heparin-Induced Thrombocytopenia – Stuart

Tenets of Play Therapy for Difficult Patients – Hughes

Emotionally activated patients:  unmet childhood needs, pts will repeat themselves and their behaviors, result of trauma in childhood that resulted in failed development of coping skills in certain situations. Key skills: Structuring Skill: Setting the tone for the visit.  "I've got about 10 minutes, but I want to address your concerns..." Guides pts to understand… Continue reading Tenets of Play Therapy for Difficult Patients – Hughes

Idiopathic Thrombocytopenic Purpura (ITP) – Kaufman

ITP is an acquired disorder of platelets:  consider as either increased destruction or decreased production. Classified as primary (a dx of exclusion) vs secondary. Etiology:  Caused by anti-platelet IgG directed against membrane proteins of the platelets. Inciting events:  infection vs immune alteration.. Incidence:  highest in children, and increased incidence with increased age in adult. DDx:… Continue reading Idiopathic Thrombocytopenic Purpura (ITP) – Kaufman

Opportunistic Infections in Transplant Patients – McCarthy

Our case:  2015 renal transplant, nocardia diagnosed shortly after immunosuppressive therapy, possible hx of CMV. Common infections:  URI and UTI - are still common in the immunosuppressed.  Common things are common. Opportunistic infections: Viral:  CMV, JC, HBV, HCV, VZV, EBV, HSV Bacterial:  PCP, Listeria, Nocardia Fungal:  Aspergillus, TB Early Post-Transplantation:  Immediately post-op to 1 month… Continue reading Opportunistic Infections in Transplant Patients – McCarthy

Hospital-Acquired (HAP) and Ventilator-Associated (VAP) Pneumonia Updates

Pearls from presentation 3/21/17 in FMTS by Amber, PharmD: Risk factors for MDR HAP, MRSA or Pseudomonas HAP/VAP:  IV abx within 90 d. Risk factors for MDR VAP:  prior abx within 90 d, septic shock at time of VAP, ARDS preceding VAP, ≥5 d hospitalization prior to VAP, dialysis prior to VAP onset. Antibiotic regimens: Add… Continue reading Hospital-Acquired (HAP) and Ventilator-Associated (VAP) Pneumonia Updates

Heart Failure with Preserved Ejection Fraction (HFpEF) – NEJM

Notes from NEJM Review Article:  Redfield MM. (2016), Heart Failure with Preserved Ejection Fraction Case:  73 yo woman seen for hospital f/u after admission for AF with RVR and pulm edema.  She c/o fatigue and DOE. Cr 1.4, eGFR 37, NT-proBNP 300.  Echo EF 70% with nl LV dimensions.  Elevated LA pressure and pulm arterial… Continue reading Heart Failure with Preserved Ejection Fraction (HFpEF) – NEJM

Acute Pancreatitis

Adapted from NEJM 11/17/2016 review article "Acute Pancreatitis": CAUSES: Gallstones EtOH (must be chronic use, 4-5 drinks/d x >5y) Usu acute-on-chronic pancreatitis Binge drinking does not cause acute pancreatitis Drugs (<5%) azathioprine 6-mercaptopurine valproic acid ACEIs mesalamine Idiopathic more frequent with age NON-CAUSES: Sphincter of Oddi dysfunction Pancreas divisum Binge EtOH use (in absence of… Continue reading Acute Pancreatitis