Tonight, we had our last Women in Medicine event of the academic year. It was a PAINT NIGHT with Cathy Cichon. (If you haven’t seen her work, check out her instagram). The picture was based on Rosalind Franklin, who is the OG Woman Scientist. Her work was central to understanding the structure of DNA. Watson and Crick wouldn’t have been able to do it without her. So now…MANY years later, we are giving credit where credit is due and honoring her with our paintings. See you again at the start of the next academic year. You are in good hands with the new leader of Women in Medicine, Chief Medical Resident Kim Chau!
This morning was a review of microcytic anemia! Why? Because you will frequently see iron-deficiency and anemia of chronic disease in real life AND thalassemia is tested on boards! Thank you Dr. Stacy Charat for coming as our expert discussant!! Check out the diagnostic schema below: HOT TIPS: — A patient with alpha-thalassemia trait will often have only mild anemia with more severe microcytosis (think 60s!). Treatment for alpha-thalassemia is observation! And iron avoidance. — In iron deficiency anemia, the MCV is the last thing to change. A person can be iron deficient with a normal hemoglobin and MCV or have a normocytic anemia. If someone complains of fatigue but their hemoglobin is normal, consider checking a ferritin! A ferritin <15 is virtually diagnostic of IDA. — Hemoglobin electrophoresis is helpful when considering thalassemia. Alpha thal trait electrophoresis will be normal Alpha thal will have elevated Hgb H Beta thal will have increased Hgb A2 and Hgb F — In
Have you heard? The VA census has been high! So today, we took a wellness morning and played telephone pictionary.
Today at the VA, we reviewed cognitive impairment and some of its causes with Dr. Huege, UCSD psychiatrist! We started with a case of a 74 yo man presenting with memory complaints (names, dates, directions) and a MOCA of 27/30. His IADLs and ADLs were unaffected. At this point, he was diagnosed with mild cognitive impairment; however, he was referred to neuro-psych testing for full evaluation. The patient never had this completed. A year later he was hospitalized after a suicide attempt with recent history of depression, agitation, and delusions about his neighbor and guns. He was started on risperidone and zoloft. At this time, his memory impairment was “stable.” He was diagnosed with MCI with depression with psychosis. On follow up, he was noted to have improved depression but worsening cognition with a MOCA now of 20/30. Physical exam revealed bradykinesia and cogwheel rigidity. He was sent back for neuro-psych testing, which reveled a diagnosis of dementia, suspected to
First, let’s start by recognizing that the toxic shock syndrome (TSS) illness script is more than just shock associated with super absorbent tampons in young adult women. While TSS is rare, providers need to be able to recognize it in order to save lives! Some of our residents, including our PGY2 Rehan, have seen this syndrome recently!! We started the morning split into groups. Each team created their own illness script for TSS, which included PICTURES. The general TSS illness script quadfecta is rapid onset of fever, rash, (often including the palms and soles), hypotension, and multiorgan system involvement! We then talked about the 2 bad bugs that cause TSS. So what does our full illness script look like? TSS secondary to staph aureus typically occurs in young adults and is associated with tampon use, nasal or other wound packing, and pregnancy related infections. The clinical criteria include fever, rash, desquamation, hypotension, and multisystem involvement (3 or more). A confirmed