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Game Time

Game Time. 8 /30/11. Medical Pyramid. 4 slides, 120 seconds Do not use ANY mentioned name or acronym on the slide 1 word hints only – no acronyms 1 at a time, no interruptions or jumping So if you see Pulmonary Embolism and want to say DVT – you CANNOT say DVT

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Game Time

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  1. Game Time 8/30/11

  2. Medical Pyramid • 4slides, 120 seconds • Do not use ANY mentioned name or acronym on the slide • 1 word hints only – no acronyms • 1 at a time, no interruptions or jumping • So if you see Pulmonary Embolism and want to say DVT – you CANNOT say DVT • Say instead Deep and hope your next colleague gets the hint and says Venous and the next says Thrombosis. • Or just jump to Thrombosis

  3. Trial Run

  4. Charcot Triad

  5. Fever Jaundice Abdominal Pain Gallstones Pericholecystic fluid

  6. Round 1 Team A

  7. What is the disease?Team A Rhuematoid Arthritis

  8. TeamA Devic Syndrome

  9. Team A Alzheimer’s Disease

  10. Team A Dermatitis Herpetiform

  11. Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. • Diagnostic criteria: • Two or more swollen joints • Morning stiffness lasting more than one hour for at least six weeks • Arthritis of hand joints • Symmetric arthritis • Rheumatoid nodules • Rheumatoid factor • Radiographic changes (erosions or uniequivocal bony decalcifications) • The detection of rheumatoid factors or auto antibodies against ACPA such as auto antibodies to mutated citrullinated valentine can confirm the suspicion of rheumatoid arthritis • Treatment: • DMARDs • BIOLOGIC AGENTS

  12. Neuromyelitisoptica (NMO)= Devic's disease or Devic's syndrome, is an autoimune, inflamatory disorder in which a person's own immune system attacks the optic nerve (optic neuritis) and spinal (myelitis). Although inflammation may also affect the brain, the lesions are different from those observed in the related condition multiple sclerosis (MS). Spinal cord lesions lead to varying degrees of weakness or paralysis in the legs or arms, loss of sensation (including blindness), and/or bladder and bowel dysfunction.

  13. Incurable, degenerative, and terminal disease was first described by German psychiatrist and neuropathologistAloisAlzheimer in 1906 and was named after him. Most common symptom is inability to acquire new memories, observed as difficulty in recalling recently observed events. Symptoms include confusion, irritability and aggression, mood swings, language breakdown, long-term memory loss, and the general withdrawal of the sufferer as the senses decline The NINCDS-ADRDA Alzheimer's Criteria specify eight cognitive domains that may be impaired in AD: memory, language, perceptual skills, attention, constructive abilities, orientation, problem solving and functional abilities.

  14. Dermatitis Herpetiform • Not caused by Herpes virus • Icthcy, chronic papulovesicular rash • Cutaneous manifestation of Celiac Sprue • IgA antibodies to gluten-tissue transglutaminase • Dx : IgA Antibodies or IgA deposits on dermal papillae • Rx: • Gluten free diet (do IgA before diet, else false negative) • Dapsone

  15. Round 1 Team b

  16. Team B Paraneoplastic Phenomenon

  17. Team B PSA

  18. Team B Polycythemia Vera

  19. Team B Ramsay Hunt Syndrome

  20. Common Paraneoplastic Associations • Small Cell Lung Ca • SIADH • Cushings • Eaton Lambert • Carcinoid Squamous Cell Carcinoma • Hypercalcemia 2ndary to PTH like substance • Horners Syndrome – Ptois, Miosis, Anhydrosis • Pancoast’s tumor AdenoCa • Pulmonary Osteoarthropathy – common presentation

  21. PSA was first identified by researchers attempting to find a substance in seminal fluid that would aid in the investigation of rape cases. PSA is now used to indicate the presence of semen in forensic serology. Obesity has been reported to reduce serum PSA levels. PSA levels can be also increased by prostatitis, irritation(DRE), benign prostatic hyperplasia (BPH), and recent ejaculation. PSA levels are monitored periodically (usually every 6–12 months) after treatment for prostate cancer. If surgical therapy (i.e., radical prostatectomy) is successful at removing all prostate tissue (and prostate cancer), PSA becomes undetectable within a few weeks. A subsequent rise in PSA level above 0.2 ng/dL is generally regarded as evidence of recurrent prostate cancer after a radical prostatectomy

  22. A classic symptom of polycythemiavera is itching, particularly after exposure to warm water. Because polycythemiavera results from an essential increase in erythrocyte production, patients have a low erythropoietin (EPO) level. JAK2 mutation is strongly associated with this condition

  23. Ramsay Hunt Syndrome VZV infection involving facial nerve Facial nerve palsy (Bell’s Palsy) Vesicular rash of the ear and mouth Tinnitus Deafness Rx : Corticosteroids ± Acyclovir (utility of Acyclovir is questionable)

  24. Round 2 Team A

  25. Team A Disseminated Intravascular Coagulopathy

  26. Team A Vitamin D Deficiency

  27. Team A Direct Thrombin Inhibitors

  28. Team A Code White

  29. Risk factors for DIC include: • Blood transfusion reaction • Cancer, especially certain types of leukemia • Infection in the blood by bacteria or fungus • Liver disease • Pregnancy complications (such as placenta that is left behind after delivery) • Recent surgery or anesthesia • Sepsis (a serious infection) • Severe tissue injury (as in burns and head injury) • Symptoms • Bleeding, possibly from multiple sites in the body • Blood clots • Bruising • Drop in blood pressure

  30. VIT D DeficiencySymptoms Bone pain Delayed tooth formation Dental deformities Muscle cramps Poor growth in children Spine and other bone deformities Stooped posture and a loss of height Tingling Weakness

  31. Direct Thrombin Inhibitors • Lepirudin (Refludan) • Approved for HIT • Renal clearance • Bivalirudin (Angiomax) • Renal clearance • Dabigatran (Pradaxa) • Approved for Afib (150 mg bid) • Renal cleared • Argatroban • Hepatic Clearance

  32. Round 2 Team B

  33. Team B Parkinson’s Disease

  34. Team B Thrombotic thrombocytopenic purpura

  35. Patients Vitals are good and stableWhat is the diagnosis?

  36. Team B MAR

  37. The disease is named after the English doctor James Parkinson, who published the first detailed description in An Essay on the Shaking Palsy in 1817 • Early in the course of the disease, the most obvious symptoms are movement-related, including shaking, rigidity, slowness of movement and difficulty with walking and gait. • Later, cognitive and behavioral problems may arise, with dementiacommonly occurring in the advanced stages of the disease.

  38. Extensive microscopic thromboses to form in small blood vessels throughout the body Most cases of TTP arise from inhibition of the enzyme ADAMTS13, a metalloprotease responsible for cleaving large multimers of von Willebrand factor (vWF) ; Plasmapheresis has become the treatment of choice for TTP Thrombocytopenia, hemolysis, fever, ARF, neurologic symptoms.

  39. Pericarditis Diffuse ST segment elevation PR depression in PR Late stage : Can have persistent TWI after ST normalise Can be treated outpatient Inpatient if signs of hemodynamic instability, raised cardiac enzymes, signs of tamponade, features of myopericarditis

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