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A case of fever of unknown origin. Part I. 

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A special thank you to Dr. Kate Erickson for providing the excellent table we used for our discussion this week! You can download this table and check out all of our afternoon report pearls on our website, https://imchiefs.unm.edu/2019/01/10/uh-ar-acute-monoarticular-joint-inflammation/! 

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Here are this week's Afternoon Report Pearls:

Clinical Pearl #1: Know the age groups and specific populations you will see each disease process in: 

1. HELLP – Pregnant patients
2. ITP
   1. Medications
   2. Patients with other autoimmune disorders
   3. Patients with HIV or Hepatitis C
3. TTP
   • Medications
   • Pregnant patients
   • Usually 3rddecade if life
   • Patients with HIV infection
   • Patients with SLE or APS
   • Stem cell transplant
4. HIT - Previous exposure to Heparin products
5. HUS - History of diarrhea 
6. DIC
   • Sepsis
   • Burn patients
   • Trauma patients
   • Metastatic cancer
   • Acute promyelocytic leukemia
   • Recent blood transfusion
   • Snake Bite

Clinical Pearl #2: Obtain the following labs: 

1. BMP: Is the Cr elevated or normal?
2. CBC: Is anemia present or absent?
3. PBS: Are schistocytes present or absent? 
4. Coagulation studies: Are the PT/PTT normal or prolonged?
5. LDH: Is the LDH normal or elevated?  

Clinical Pearl #3: TTP clinical manifestations can be remembered by using the mnemonic: RAFT'N. 

1. R - Renal failure
2. A - anemia
3. F - fever
4. T - Thrombocytopenia
5. N - Neurological deficits 

Remember, TTP is ALWAYS an EMERGENCY!!!

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A case of lower extremity edema. Episode 2 is sponsored by Krystal's cooking! If you enjoy the podcast, please subscribe and rate us below! Thank you!

Afternoon Report Pearls: 

1. The definition of nephrotic range proteinuria is either >3500mg of protein in a 24hr urine collection OR a spot urine protein/creatinine ratio >3500mg/g. 
2. For nephrotic syndrome, the nephrotic range proteinuria must be accompanied by hypoalbuminemia, edema, and hyperlipidemia. 
3. Nephrotic syndrome may be primary/idiopathic or secondary. Most adult patients with nephrotic syndrome require a kidney biopsy to obtain a definitive diagnosis.
4. Secondary causes for membranous glomerulopathy should be sought, particularly occult malignancy in older patients. 

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A case of acidosis and bradycardia. 

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