Our Chiefblog here is no longer being maintained or updated. Please visit our new, updated site IMIOWA.COM ..read more

Please see each division’s research presentations and point(s) of contact below: Cardiology Points of Contact: Barry London, MD, PhD and Ferhaan Ahmad, MD, PhD Endocrinology Point of Contact: Brian O’Neill, MD, PhD General Internal Medicine Points of Contact: Richard Hoffman, MD, MPH and Peter Kaboli, MD Gastroenterology / Hepatology Point of Contact: Arvind Murali Hematology / Oncology Points of Contact: Daniel Berg, MD and Usha Perepu, MBBS, MRCP  Infectious Disease Point of Contact: Judy Streit, MD Palliative Care Point of Contact: Yuya Hagiwara, MD, MACM Pulmonary / Critical Care Poin ..read more

Today we had an excellent outpatient case presentation by Dr. Chen. A patient presented with rash consistent with Erythema Multiforme. The rash was present on his palms. Here are some quick take away points. What is a quick differential and scenarios of a rash involving the palms (and soles)? Hand-foot-and-mouth disease (Coxsackie virus) papulovesicular lesions, oral lesions, in children or with exposure to children Rocky Mountain Spotted Fever (Rickettsia rickettsii) petechial, starting on wrist and ankles and spreading to the palms / soles / trunk remember outdoor exposure and geography ..read more

Today we had an excellent case of progressive SOB / DOE with a finding of bilateral pleural effusions and thickening presented by Dr. Bowmaster. Some take-aways from the case are as follows; Pleural effusion – who and when to tap? In general, ALL new effusions! Exceptions include if SMALL effusion AND clear clinical diagnosis, ex. viral – pleurisy, CHF Atypical features to consider tapping; s/sx of infection or cancer, high A-a gradient, bilateral effusions of different sizes (Some) Chest tube indications Complicated parapneumonic effusion Empyema Positive gram stain or fluid cultures Locul ..read more

Today’s lecture was about inpatient management by Dr. Polyak. He also used an algorithm he developed with our very own Dr. Dhedhi (currently GI fellow at SLU). You can find here the: Slides – Inpatient Management of IBD 2020 Associated article – Inpatient Management of Inflammatory Bowel Disease Related Complications. CGH 2020 Algorithm –Severe UC Protocol v8   AS ..read more

Today’s morning report was about elderly patient with MM s/p SCT on chemotherapy admitted with very high fever, tachycardia and morbiliform rash on trunk as well as lesion on L arm. The lesion quickly evolved into bulla, patient was appropriately treated with broad-spectrum antibiotics. Cultures the next day (from blood and from lesion) grew Pseudomonas leading to diagnosis of ecthyma gangrenosum. Similar case from NEJM with some more information here nejmicm1702302 Also check out Amanda’s slides morning report (Heuszel, Amanda) Most importantly from this case is DDx for fever + rash in this p ..read more

Today we discussed a middle-aged patient with 15 year history of dyspnea and fatigue. Previous investigations revealed obstructive PFTs, ground-glass opacities on CT imaging and noncaseating granulomas on lung biopsy. We discussed the DDx of granulomatous disease in the lung (not only sarcoidosis / fungal infections!). Further history for exposures revealed daily use of a hot tub (with a malfunctioning filter!). Removal of the hot tub exposure alleviated most of the patient’s symptoms. This is a interesting case from NEJM with similar discussion in a more acute presentation. nejmcpc059003   AS ..read more

Today we had an excellent noon conference by Dr. Shibli-Rahhal on Male Hypogonadism. This topic is also highly testable! Please review the PDF attached for some high yield teaching points.   -SA   Male Hypogonadism- resident lecture 2020 ..read more

Today we presented a case of middle-aged patient presenting with back pain. We discussed MSK reasons of back pain as well as red flags, physical exam. The patient was treated conservatively and came for follow-up a few months later with lytic lesion in his pelvis. We then discussed bone lesions, lytic-blastic spectrum and non-malignant DDx for lytic bone lesions. The patient was ultimately diagnosed with blastomycosis – bone lesions being one of the most common extra-pulmonary manifestations of blastomycosis. More information on the slides bone lesion – 1.17 Take home points: Back pain with re ..read more

Today for conference we discussed a case of a young patient presenting with SOB and hemoptysis. On initial labs found to have creatinine of 14. We discussed pulmonary-renal syndromes (and other reasons for a young patient with kidney disease to present with respiratory failure). Subsequent evaluation after normal complement, ANCA and GBM included renal biopsy which showed IgA nephropathy. More information on the slides IgAN – 1.13 and on this review article from NEJM nejmra1206793. Take home points: It is important to develop a systematic approach to diagnosing AKI Distinguish Nephrotic from N ..read more