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Radiographic appearances of pulmonary diseases in HIV/AIDS Patients • Diffuse Interstitial Infiltrates: Pneumocystis jirovecii, M.tuberculosis, Histoplasma capsulatum, Coccidioides spp., Cryptococcus neoformans, Toxoplasma gondii, Cytomegalovirus, Influenza, Lymphocytic interstitial pneumonitis, Abacavir hypersensitivity; Drug toxicity, Pulmonary edema; ARDS, Metastatic disease, Pulmonary alveolar proteinosis • Hilar adenopathy: M. tuberculosis, H.capsulatum, Coccidioides spp, Non-Hodgkin's (NHL) or Hodgkin's lymphoma, Mycobacterium avium complex • Nodular/Masses: M.tuberculosis, C.neoformans, Aspergillus spp., H.capsultaum, Nocardia spp; Actinomyces spp., NHL; Lung cancer, Kaposi sarcoma, Castleman's disease • Pleural effusion: Parapneumonic effusion; empyema, M.tuberculosis, Lymphoma (NHL, primary effusion lymphoma), Kaposi's Sarcoma • Focal Consolidation: Pyogenic bacterial pneumonia, M. tuberculosis, Legionella spp., Rhodococcus equi, Bronchoalveolar cancer, Organizing pneumonia • Cavitary disease: Pyogenic bacterial pneumonia from P.aeruginosa, S. aureus, Enterobacterales; M. tuberculosis, C.neoformans, R.equi, Aspergillus spp., Nocardia spp., Mycobacterium avium complex, P.jirovecii • Pneumothorax: P.jiroveci • Normal radiograph: P.jiroveci, M. tuberculosis Infectious Diseases Fellows Network @ID_fellows #HIVAIDS #pulmonary #diseases #differential #diagnosis #chestCT #radiology
Pes Anserine Bursitis on POCUS Pain in proximal medial shin. Maximal tenderness over the anechoic area adjacent to bone. Diagnosis? Pes anserine 'bursitis' Dr. David Mackenzie @mackendc #PesAnserine #Bursitis #POCUS #MSK #ultrasound #clinical #knee
Metabolic Alkalosis - Differential Diagnosis Algorithm • Cl- responsive metabolic alkalosis - Kidney loss of Cl-: Remote use of loop or thiazide diuretics, Post-hypercapneic metabolic alkalosis - Loss of Cl- outside the kidneys: Gastrointestinal (Vomiting/nasogastric suction, Congenital chloride diarrhea), Sweat (Cystic fibrosis) • Cl- resistant metabolic alkalosis - Normal/low blood pressure: Active diuretic use, Bartter syndrome, Gitelman syndrome, Hypomagnesemia - Hypertension: Increased mineralocorticoid or mineralocorticoid-like effect) • Normal gap metabolic acidosis: Chronic diarrhea, Kidney tubular acidosis • Anion gap metabolic acidosis: Diabetic ketoacidosis, Starvation ketoacidosis, Alcoholic ketoacidosis, D-lactic acidosis, Chronic salicylate poisoning • Normal acid-base status: LiCl use #Metabolic #Alkalosis #Differential #Diagnosis #Algorithm #causes
Enhanced peritoneal stripe sign suggestive of free air in the peritoneum (also known as that other EPSS) on POCUS 80 yo M with abdominal pain. Hypotensive and tachycardic on arrival. #POCUS performed prior to CT. What's abnormal in this RUQ view? MaimoUltrasound @MaimoUltrasound #EPSS #pneumoperitoneum #freeair #clinical #pocus #abdominal
Echinococcus Life Cycle 1) Adult in small intestine eggs 2) Embryonated egg in feces 3) Oncosphere hatches; penetrates intestinal wall 4) Hydatid cyst in various organs (commonly liver and lung) 5) Protoscolex from cyst 6) Scolex attaches to intestine #Echinococcus #LifeCycle #diagnosis #pathophysiology #infectiousdiseases #cdc #parasite
Anisakiasis - Life Cycle Anisakis, Pseudoterranova, Contracecum 1) Definitive hosts excrete unembryonated eggs in 2a) Eggs become embryonated in water and L3 larvae form in the eggs. 2b) L3 larvae hatch from eggs as ensheathed, free-swimming forms. 3) Free-swimming larvae are ingested by crustaceans, and develop in the hemocoel. 4) Infected crustaceans are eaten by fish or cephalopod paratenic hosts. L3 larvae released in digestion migrate to the mesentery and muscle tissues, and can be transferred to other paratenic hosts via predation. 5) Paratenic hosts maintain L3 larvae in tissues, which are infective to definitive hosts. 6) Marine mammal definitve hosts ingest fish/squid paratenic hosts, and L3 larvae develop into adults in the gastric mucosa. 7) Transmission to humans via raw or undercooked seafood consumption. Diagnosis of anisakiasis can be made by gastroscopic examination during which the larvae can be removed. #LifeCycle #diagnosis #pathophysiology #infectiousdiseases #cdc #parasite
Partial tear of subscapularis tendon on POCUS The partial tear (hypoechoic) area is clearly seen in the subscapularis tendon. And - it is not anisotropy. Abdulwahed AL zaher @WYIAnX4oUlPPqr5 #tear #subscapularis #tendon #POCUS #clinical #ultrasound #msk
Causes of Leukocytosis and Leukopenia - Differential Diagnosis • Eosinophilia (AEC > 500, hypereosinophilia > 1500): Allergic, Connective Tissue, Infections, Malignancy • Eosinopenia: Sepsis, Increased cortisol • Lymphocytosis: Infection, Malignancy, Autimmune, Drugs • Lymphocytopenia: Infections, Autoimmune, Medications, Cancer, Nutritional Deficiencies • Neutrophilia: Reactive (Infection, medications, other / inflammation), Neoplastic • Neutropenia: Infections, Drugs, Autoimmune, Bone Marrow Failure, Autoinflammatory, Nutritional Deficiencies, Benign ethnic neutropenia • Monocytosis: Infection, Malignancy, Autoimmune Dr. Ann Marie Kumfer @AnnKumfer #Leukocytosis #Leukopenia #Differential #Diagnosis #causes #hematology
How much sodium is in 1 Liter of Normal Saline? In Bags if Potato Chips 1 L of normal saline = 0.9% sodium chloride contains 154 meq of sodium per liter. 1 L normal saline x (154 meq/L) x (23 mg Na+/meq) = 3,542 mg Na A 1 oz. bag of Lay's Classic potato chips contains 180 mg of sodium. Thus, 1 L of normal saline has about as much sodium as 20 bags of chips. Bryan Carmody @jbcarmody #bags #chips #lays #normal #saline #ns #nephrology #sodium #comparison #hotdogs #conversion
Bullous Pemphigoid - Diagnosis and Management Summary Pathophysiology: Autoantibody-mediated damage to epithelial basement membrane -> separation of epidermis from dermis Clinical Signs/Symptoms/Exam findings: - Prodrome: pruritic, inflammatory plaques (may resemble eczema or urticaria) weeks to months bullous phase - Bullous phase: tense 1-3 cm bullae, often pruritic. Most commonly located on trunk, flexural surfaces, and axillary and inguinal folds - Erosions and crusts at sites of ruptured bullae - Mucous membrane involvement with blisters/erosions in ~20% Management: 1. High-potency topical steroids 2. Systemic glucorticoids if 1) not feasible CMC IM Residency @CMC_IM #Bullous #Pemphigoid #Diagnosis #Management #dermatology