Today the VA reviewed a case of a young patient (35) presenting with hemoptysis. Our residents broke things down into a few main triage questions to start off with:
- How much blood is coming out?
- Is the patient able to cough it up on their own? What’s their respiratory status?
- What’s the patient’s hemodynamic status?
These questions will help you get a sense of how severe the patient’s condition is, because hemoptysis can range from totally benign to immediately life-threatening. If this person needs to go to the ICU, be intubated, or even have CT surgery called, we need to know as soon as possible!
Once it was revealed that this patient was stable and able to expectorate their blood without significant distress, the teams shifted to differential. 90% of significant hemoptysis is due to bronchial arterial bleeds, and bleeding can occur in the airway itself, parenchyma, or even as a result of vascular dysfunction or defects.
The UCSD Hillcrest and Thornton Cafeterias will be serving a Thanksgiving Meal on 11/26:
There will be 2 meal options, employees can pick one entrée, no substitutions.
– Roasted Turkey Breast
– Stuffing with Pecans & Dried Fruit
– Whipped Potatoes
– Green Bean Casserole
– Pineapple Glazed Ham
– Stuffing with Pecans and Dried Fruit
– Baked Sweet Yams
– Cauliflower Polonaise
Both entrées come with the following:
– Green Salad
– Pumpkin Pie with Whipped Cream
– Dinner Rolls & Butter
– Choice of 7.5oz Soda OR Bottled Water
Saturday December 12th, 2020
7:30 am- 1:00pm
Use hyperlink below to register for Zoom Webinar
UC San Diego Transgender Health Care Symposium scheduled for Saturday, December 12, 2020. The UC San Diego Transgender Health Care Symposium will provide a comprehensive review of different aspects of gender-affirming medical care. This course will feature sessions on gender-sensitive cultural awareness, behavioral health care, primary care, and medical and surgical gender-affirming interventions. All topics will be presented to help providers from varied disciplines care for this population in a sensitive and effective manner. The program will be delivered in topic-specific sessions, each followed by a brief question and answer opportunity.
This course is targeted toward anyone interested in in-depth exposure to medical care for the transgender patients, including physicians (in practice and in training) and allied health professionals in primary care, endocrinology, plastic surgery, urology, obstetrics/gynecology, as well as mental health professionals, social workers and nurses, and students of all above disciplines.
More information regarding the course is available online, please visit https://cpd.ucsd.edu/transgender.
- Plastic Surgery at UCSD for Transgender Individuals – Amanda S. Gosman, MD
- Mental Health for Transgender Individuals – Darlene Tando, LCSW
- Adolescent Medicine and Transgender Health – David Inwards-Breland, MD
- Transgender Patient Experience Panel: Patients Share Their Experience as Transgender Patients
On 11/19 we discussed a case of acute GVHD with our wonderful expert discussant Dr. Aaron Goodman. Our patient underwent allogenic BMT and developed acute watery diarrhea on day 21 post transplant. They were found to have acute GVHD.
- We discussed differential and workup of acute diarrhea in an immunosuppressed patient. Differential should include infectious (CMV, cdiff, parasitic, ect …), medication induced, and immunologic (mucositis, GVHD).
2. We also discussed common complications of bone marrow transplant at less than 30 days post transplant including infection, cytopenias, thrombotic microangiopathy, hepatic sinusoidal obstruction syndrome, mucositis, GVHD.
3. Additionally we reviewed acute GVHD. Acute GVHD occurs when immune cells transplanted from a non-identical donor (the graft) recognize the transplant recipient (the host) as foreign. This will then initiate an immune reaction that leads to disease in the transplant recipient. Usually occurs <100 days post transplant. Classic symptoms include, maculopapular rash, persistent nausea and/or emesis, abdominal cramps with diarrhea, and a rising serum bilirubin concentration.
Today during Friday School, we had several sessions combining both oncology- and hematology-related topics!
For the residents, our first session was given by Dr. Aaron Simon, radiation-oncology chief resident at UCSD. Dr. Simon focused on rad-onc terminology and modalities of treatment. He covered radiation side effects in various organ systems and their management in the inpatient and outpatient setting. We then discussed specific cases centered on common inpatient rad-onc consultations, including spinal cord compression and brain mets.
Our second resident session was led by Dr. Lisa Madlensky certified genetic counselor and the director of the Family Cancer Genetics Program at UCSD. She discussed the importance of taking a detailed family history in determining possible familial cancer risk. We then discussed common cancer syndromes (BRCA, HNPCC) and finished with some guidance on the role and details of genetic testing, familial testing, and interpreting results.
Our combined resident/intern session started with an interactive AHEAD curriculum exercise entitled “The Power of Words” run by CRQS chief DJ Gaines. The activity was based on a study by Goddu et al (2017). entitled “Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record” published in the Journal of General Internal Medicine. Our residents read a clinical vignette in written in “stigmatizing” language, answered management questions based on the vignette, and read the same vignette written in neutral language before readdressing the same management questions. The exercise sought to highlight the importance of neutral language in patient charts to reduce bias and ultimately access to care.
The final resident/intern session was lead by Dr. Srila Gopal, the director of UCSD’s Adult Sickle Cell Disease program. She taught us about the origins of sickle cell disease, its pathogenesis, genetic variants and their phenotypic differences, and traditional and emerging treatments for SCD. Our Friday School session concluded with a conversation with one of her patients, Ms. Williams, who graciously offered her time this afternoon to speak to our residents. Our poignant conversation with her highlighted the inequities, biases, and barriers to equal treatment that exist for many patients with Sickle Cell disease.
Today in Jacobs Oncology conference, we learned about a case of a 68 YO man with metastatic melanoma on ipilimumab/nivolumab therapy who presented to the ED with diarrhea and was ultimately found to have both checkpoint-inhibitor-related colitis as well as possible C-diff colitis. We discussed the various common immune-related adverse events (irAE’s) that can occur after immune checkpoint inhibitor (ICI) therapy as well as the grading of ICI-related colitis and its treatment.
Take home points:
1.) irAE’s can involve various organs and systems, including skin, heart, lungs, liver, intestines, kidneys, adrenal, thyroid, and pituitary glands.
2.) ICI-related colitis is a potentially serious irAE that can result in colonic perforation if left untreated. Treatment includes high-dose corticosteroids (1-2mg/kg/day of methylprednisolone), infliximab for steroid-refractory disease, and vedolizumab as a third-line agent
CALLING ALL FUTURE HEMATOLOGISTS AND ONCOLOGISTS!
Please join us on Monday, 11/30/20 from 5:30-6:30 PM over zoom for our Heme/Onc interest group meeting! Our fellowship APD, Dr. Wong; our chief fellow, Dr. Justin Shaya; some of our other fellows, and some of our R3’s who applied this cycle will all be there to answer your questions about Heme/onc as a field, applying to fellowship, and finding research opportunities!
Check your emails for the zoom link!