Dear UCSD IM Residency Family,
Happy Thanksgiving to you and your loved ones!
We want you to know how deeply grateful we are to you for the outstanding care you provide to our patients each day, and the commitment you demonstrate to your own education and growth as physicians. This is an incredibly important time in your careers and in your lives; we recognize what huge sacrifices it requires of you.
We would like to extend a special, heartfelt, thanks to all of you who are in the hospital caring for our patients today and during holidays throughout the year. During your training, and throughout your careers as physicians, each of you will spend many special days with our patients and our extended healthcare family, rather than with your immediate family and loved ones. It is an incredible privilege to be a physician, but also an immense responsibility, and we want you to know how very proud we are of each of you for dedicating yourself to this important mission.
We also want to acknowledge what a particularly difficult time the last two years have been, due to the COVID pandemic. We know it has been very challenging for many of you to see your families across the country and the world. We are incredibly grateful that this year, access to vaccination will allow many of us to reconnect with family. Thank you for remaining vigilant in protecting yourselves, our IM residency family, and our extended patient and healthcare family during this critical time.
Thank you! We are so thankful for each and every one of you!
simerjot (on behalf of the UCSD Internal Medicine Residency Program, the Department of Medicine, and our patients)
Today at Jacobs, two of our fabulous third-year residents, Mitch Biermann and Jared Rosen, presented the evidence behind two topics:
- Risk of DVT embolization with mobilization of patients with a PE
- Efficacy of bronchoscopy in immunocompromised hosts in determining etiology of lung infiltrates
They did a great job reviewing the literature behind both of these topics!
Mitch found that mobilization after a PE is not associated adverse outcomes, and Jared found that for lung infiltrates in immunocompromised patients, the best diagnostic efficacy is with combined BAL and biopsy. Thank you for the interesting presentations, Mitch and Jared!
Today for Owen morning teaching conference, we discussed a 30-year-old gentleman who presented with headaches. He was recently hospitalized earlier in the year for multiple lower extremity MRSA abscesses, and at that time, his CD4 count was 7. On work-up of his headaches, a CT head and neck was performed, which incidentally picked up cavitary lung lesions. Triggering a discussion of the differential and initial work-up for cavitary lung lesions.
We created a broad differential using the buckets of infections (further broken down into bacteria, mycobacteria, and fungi), malignancy, autoimmune disorders, and vascular disease. We reviewed images from each of these categories discussing what might distinguish them from each other on CT. During the patient’s prior admission, he had some initial work-up done including AFBs and fungal serologies. Notably his serum CrAg was positive with a titer of 1:20; however his CSF CrAg was negative at that time.
An LP was performed in the ED after the CT head revealed no space occupying lesions and his CSF CrAg this time was positive with a titer of >1:10,240. He was initiated on Amphotericin and Flucytocine for Cryptococcal meningitis; however, the cause of his cavitary lesions needed a bit more work-up.
He ultimately underwent a bronchoscopy with BAL and FNA. The pathology from his lung tissue revealed:
= Lung parenchyma with many foamy macrophages and rare fungal organisms with thick capsule (positive with mucin-carmine) stain, consistent with Cryptococcus.
Thank you to Dr. Tom Martin for joining us as our expert today and for all of your pearls!
Our wonderful Program Director, Dr. Jassal, was recognized by the American College of Physicians (ACP) for making a positive impact on the women in medicine community by working towards gender equality in medicine and supporting the advancement of women in medicine! Congratulations, Dr. Jassal! We truly appreciate your efforts to promote equity. This award is well deserved!
We are so thankful for our amazing VA wards teams and the excellent care they provide to patients! This morning, we took time to practice gratitude by drinking coffee and crafting turkeys! Our residents wrote heartfelt notes to their families on the turkeys, and we’ll be mailing them home for the holiday all across the country! Happy Thanksgiving!
CareerMD will be hosting a Career Fair and Networking Reception for residents and fellows in Orange County on the evening of Monday, December 13, 2021. This event will be held between 5:00pm and 8:00pm at Embassy Suites by Hilton Anaheim Orange, located at 400 N State College Blvd in Orange County.
More than 10 regional and local hospitals and healthcare organizations that are actively hiring in all medical specialties will be present.
This event is free of charge to all residents, fellows, and their guests. Food and drinks will be served.
If you are interested in attending, please RSVP online at https://www.careermd.com/OrangeCounty.
We had a lot of fun this morning at the VA playing medical Pictionary! Some highlighted drawings included: code green, code blue, student loans, telemedicine, vanc/zosyn, CRPS, aortic stenosis, SBP and sundowning. Congratulations to team 1 for taking home the victory.
With a patient currently admitted for maxillofacial mucormycosis, we decided to make today Mucor Monday! With the help of our expert discussant and ID fellow, Dr. Rehan Syed, we reviewed some of the key features of the causative fungus, mucorales.
Dr. Syed highlighted that diagnosing mucormycosis, especially pulmonary disease, can be a challenge especially as many of the patients are immunocompromised making invasive procedures (biopsies, bronchoscopies, etc) difficult. He noted interestingly that cases have been associated with corticosteroids use in COVID-19 treatment. Also, renal cases have occurred and because the lipid formulation of amphotericin doesn’t concentrate in the urine, the conventional form (doexycholate) needs to be used.
Thank you so much to the residents for your participation and to Dr. Rehan Syed!
Dr. Cathy Logan gave an incredibly high yield talk on fungal infections focusing on immunocompromised hosts. We worked through yeast –> mold –> dimorphic fungi. We talked about the diverse pathologic presentations of the yeast species. Because prophylaxis works so well for PJP, we learned that the most common time this is seen is in patients on high dose steroids who are inadvertently not placed on ppx. We next talked about the endemic and regional dimorphic fungi (Histo is my favorite being a midwesterner and yes people do go spelunking). Cocci’s reign is expanding due to climate change – oh no! We then talked about opportunistic molds including aspergillosis and mucormycosis. Both of these pathogens, unlike the others we discussed are invasive and cause destruction of the surrounding tissues. This includes vasculature leading to necrosis. Debridement is a necessary part of treatment as our immune system of anti-infectives cannot reach the areas of necrosis. Thank you Dr. Logan, we all learned a lot!
The opening act for this afternoon’s Friday School was Dr. Castellanos with a talk on Valvular Disorders. Typically a stiff talk that is difficult to flow through, Dr. Castellanos brilliantly broke it down in a way that residents can easily regurgitate and apply to their patients.
Next Dr. Harpreet Bhatia talked on primary prevention of CV events! It’s all STATIN to make sense! Aspirin may not be needed for primary prevention, BUT it still plays a vital role in secondary prevention.
Our interns joined us just in time to learn about management of stable angina from Dr. Phreaner! It seemed light a weight had been lifted off their chest as they learned and no longer have to stress about stress tests.
Friday school’s ending was SHOCKING! As interns and residents broke into small groups to tackle cardiogenic shock cases led by Dr. Pre Bhatia with the help of cards fellows!