Clinical Manifestations:
Hemolysis --> fatigue
Cytopenias
Venous thrombosis --> acute abdominal pain, esp. portal vein thrombosis
Workup:
CBC (find hypoplastic/aplastic anemia, thrombocytopenia, leukopenia)
Lactate dehydrogenase: elevated
Haptoglobin: Low (due to hemolysis)
Indirect bilirubin: elevated
UA: hemoglobinuria
Flow cytometry: absent CD55 & CD 59 (allow autoimmune MAC complexes)
Treatment: Iron, folate, Eculizumab (inhibs complement activation)
Thursday, July 14, 2016
Thyroiditis Diseases
Thyroiditis
Disease-Clinical features-Testing: includes TPO Ab, Radioiodine test, ERS, CRP
Hashimoto Thyroiditis- Predom. hypothyroid features, diffuse goiter- Positive TPO Antibody, Variable radioiodine uptake
Silent thyroiditis=painless thyroiditis-Mild, brief hyperthyroid phase, spontaneous recovery, small painless goiter-pos. TPO Ab, Low radioiodine uptake
Subacute thyroiditis (de QuerVains)- from Virus, fever, hyPERthyroid, painful goiter-Elevated CRP, Elevated ESR, low radioiodine uptake.
Disease-Clinical features-Testing: includes TPO Ab, Radioiodine test, ERS, CRP
Hashimoto Thyroiditis- Predom. hypothyroid features, diffuse goiter- Positive TPO Antibody, Variable radioiodine uptake
Silent thyroiditis=painless thyroiditis-Mild, brief hyperthyroid phase, spontaneous recovery, small painless goiter-pos. TPO Ab, Low radioiodine uptake
Subacute thyroiditis (de QuerVains)- from Virus, fever, hyPERthyroid, painful goiter-Elevated CRP, Elevated ESR, low radioiodine uptake.
Thursday, July 7, 2016
Well's Criteria (Modified) for Pulmonary Embolism, PE
Score > 4 means PE is likely.
3 Points:
1.5 Points:
1 Point:
3 Points:
- Clinical Signs of DVT (Deep Vein Thrombosis),
- Alternative Diagnosis is less likely than PE
1.5 Points:
- Previous PE or DVT
- HR > 100
- Recent immobilization
1 Point:
- Hemoptysis
- Cancer
To confirm PE, do CT Chest with IV contrast.
2nd to 4th Metatarsal Fracture Algorithm
1. Encounter Metatarsal pain with no displacement (w/ or w/o redness and swelling, no trauma necessary). If non-reducible displacement, surgery.
2. Get an X-ray to look for fracture.
3. If no fracture found, get an MRI or Bone Scan to look for fracture. If frx found, go to 4.
4. Prescribe rest, hard-soled rubber shoe, and analgesics. If patient returns with persistent pain, 5.
5. Cast the foot, going from distal to proximal.
Notes: Reserve surgery for Jones fractures (of 5th metatarsal), or displaced fractures. We can start conservatively since the surrounding metatarsals act as splints for metatarsals 2-4.
2. Get an X-ray to look for fracture.
3. If no fracture found, get an MRI or Bone Scan to look for fracture. If frx found, go to 4.
4. Prescribe rest, hard-soled rubber shoe, and analgesics. If patient returns with persistent pain, 5.
5. Cast the foot, going from distal to proximal.
Notes: Reserve surgery for Jones fractures (of 5th metatarsal), or displaced fractures. We can start conservatively since the surrounding metatarsals act as splints for metatarsals 2-4.
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