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UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER MARCH 24, 2017
http://www.clevelandart.org/events/special-events/mix-at-cma
VACR Corner By Dr. Saurav Uppal
Looking for something to do this weekend? Want to spend some quality time with friends and family? Are you a fan of amusement parks? Well I have got some good news for you! This Friday March 24th, is the beginning of the annual I-X Center Indoor Amusement Park! When: Starting March 24th until April 17th Where: I-X Center, one I-X center Drive Cleveland OH 44135. Cost: General admission (online in advance) costs $21, You can also buy admission tickets are Marc’s Grocery store for $19.99 each or Buy a package that includes 4 tickets and 1 parking pass for $79. Children 3 years or under are FREE! This annual springtime event offers a full day of smiles, thrills and family fun. The park offers something to do for all age groups including rides for kids! All of this is available at an affordable price (Please see above). The park offers over 20 acres of rides, games, and food under one roof. It’s a great way to spend the evening with your loves ones. Some of the highlight events include: Bengal tiger encounter, See lion splash show and Zuzu Acrobats etc. It also offers different eating options including Tacos, Burgers, Stromboli and typical amusement park food (Hot dogs, elephant ears, funnel cakes). We have some warmer temperature coming our way this weekend with projected highs in the 60s so get out there and spend some quality time with your family and friends!!! For more details about the hours of operation please visit: https://ixamusementpark.com/
https://ixamusementpark.com/bengal-tiger-encounter https://ixamusementpark.com/rides/mountain-dew-thrill-city/ https://ixamusementpark.com/rides/mountain-dew-thrill-city/
Resident Newsletter UH Department of Internal Medicine Residency Program
Finally Friday
http://www.thisiscleveland.com/articles/view/it-s-easy-being-green/1286/
UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER MARCH 24, 2017
CALENDAR LINKS
Electives
Please send your elective selection to Barb. You can always
contact the chiefs for any suggestions. All reading electives
must be approved by Dr. Armitage.
Barb – [email protected]
UH HOUSEDOC moonlighting calendar
Spots open up on a month-by-month basis. You will be notified
by email from Kathy DeMarco when the monthly openings
become available.
Please send your requests to [email protected]
MICU & CICU moonlighting calendar
Spots open up on a month-by-month basis. You will be notified
by email from the Quality Chief Resident when the monthly
openings become available.
Please send your requests to [email protected]
CURRENT CHIEFS
AMBULATORY CHIEF Jacob Sadik
Pager: 31529
Office: VA ext. 5034
VA CHIEF Prashanth Thakker
Pager: 31533
Office: VA ext. 5034
QUALITY CHIEF Carine BouAbboud Matta
Pager: 36644
Office: UH ext. 43621
UH CHIEF
Jack Hornick
Pager: 32150
Office: UH ext. 43621
REMINDERS
1. For any call-offs, you MUST page the ambulatory chief at 31529. The chiefs are not always available on short notice by phone or email, but they ALWAYS have the pager.
2. For two senior ward teams: senior resident weekend days off are arranged amongst the two seniors such that each receives two weekend days during a 14 day half block.
Resident of the Week Award
This week’s Resident(s) of the Week Award is awarded to: Yuri Shindo and Justin Morrison
The seniors I worked with on white team seemed especially strong, and I wanted to make note of that. Yuri Shindo and Justin Morrison were both outstanding leaders and teachers. Yuri made time for teaching even when I know it meant she would have to stay past midnight, and she never complained or made it seem like a burden. Justin Morrison was in the midst of interviewing for fellowship positions and studying for Step 3 at night, and still made teaching a priority. I felt extremely lucky to have had them as seniors. Please remember to submit your nominations for Resident of the Week to [email protected].
UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER MARCH 24, 2017
CANDY ROUNDS RETURNS!!!
THIS WEEK’S TOP CONTENDERS!
DWORKEN – 80 points VACR – 70 points
RATNOFF – 60 points (time: 2:37)
http://www.foodgatherers.org/?module=Page&sID=candybuyback
Great job everyone!!! DWORKEN TEAM, claim your Java Jive prize
in the UH chiefs office!
QUESTIONS & ANSWERS 1) Physical exam name for inability to close eyes completely
Lagoopthalmos 2) Sunitinib and sorafenib inhibit this enzyme
Tyrosine Kinase 3) Schober test is associated with this condition
Ankylosing spondylitis 4) Cause of bright red venous blood due to mitochondrial poisoning
Hydrogen Cyanide 5) Eponym for uveitis, parotid enlargement, and fever seen in
sarcoidosis Heerfordt’s syndrome
6) Condition significantly associated with high titers of anti-U1-ribonucleoprotein antibodies
Mixed connective tissue disorer Bonus: Name an element that begins with the letter “K”
Krypton
UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER MARCH 24, 2017
NEJM IMAGE CHALLENGE
MKSAP QUESTION OF THE WEEK
A 59-year-old man is evaluated for a 3-month history of intermittent itching on the forearms. He describes the itch as deep, with a burning or tingling sensation. Scratching helps somewhat, but over-the-counter topical corticosteroids have not helped. Cooling the skin soothes the itch. He did not notice a rash until he started scratching. The itch gets worse after being in the sun, but sun exposure does not cause redness or a rash.
On physical examination, the patient shows evidence of chronic sun damage on sun-exposed skin, including hyperpigmentation and solar lentigines. A few excoriations are present on the forearms, but no significant dermatitis is observed. The patient's sensation on the arms and forearms is normal. Deep tendon reflexes are normal in the biceps, triceps, and brachioradialis.
Which of the following is the most likely diagnosis?
A) Brachioradial pruritis B) Polymorphous light eruption C) Prurigo nodularis D) Solar uritcaria
An 86-year-old woman with hypertension presents with epigastric pain and does not report any respiratory symptoms. Her chest radiograph demonstrates these findings. What is the diagnosis? A) Oleothorax B) Hemothorax C) Calcified empyema D) Non-small-cell lung cancer E) Asbestosis
UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER MARCH 24, 2017
UH CONFERENCE SCHEDULE
MONDAY, 3/27/17: Resident Morning Report 11:00 AM - 12:00 PM Noon Conference: 12:00 - 1:00 PM Dr. Ashley Trotter Senior Grand Rounds Carpenter Room
TUESDAY, 3/28/17: Intern Morning Report: 11:00 - 11:45 AM Grand Rounds: 12:00 - 1:00 PM Dr. Joan Zoltanski MD “Patient Experience” Kulas Auditorium
WEDNESDAY, 3/29/17: Resident Morning Report: 11:00 AM - 12:00 PM Noon Conference: 12:00 - 1:00 PM Dr. Bryan Bonder Senior Grand Rounds Carpenter Room THURSDAY, 3/30/17: Intern Morning Report: 11:00 AM – 12:00 PM Noon Conference: 12:00 - 1:00 PM Dr. Will Hannah Senior Grand Rounds Carpenter Room FRIDAY, 3/31/17: Resident Journal Club: 11:00 – 11:55 AM Morbidity & Mortality: 12:00 – 1:00 PM M&M Conference Kulas Auditorium
VA CONFERENCE SCHEDULE
MONDAY, 3/27/17: Noon Conference: 12:00 - 1:00 PM Attending Rounds K119 TUESDAY, 3/28/17: Resident Morning Report: 10:00 - 11:00 AM Grand Rounds: 12:00 - 1:00 PM Dr. Joan Zoltanski MD “Patient Experience” K119 (live stream from UH) WEDNESDAY, 3/29/17: Resident Morning Report: 10:00 - 11:00 AM Morbidity & Mortality Conference: 12:00 - 1:00 PM M&M Conference K119 THURSDAY, 3/30/17: Intern Morning Report: 10:00 - 11:00 AM Noon Conference: 12:00 - 1:00 PM Attending Rounds K119 FRIDAY, 3/31/17: Noon Conference: 12:00 - 1:00 PM Dr. Kristi Henzel SCI
K119
CONTACT THE CHIEFS IF YOU HAVE ANY QUESTIONS OR CONCERNS!
UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER MARCH 24, 2017
Saturday, March 25, 2017 Leanna Robertson on Blue is off and will be covered by Emad Mansoor. Rani Guttikonda on White is on medium call and covers her own team. JaMia Washington on Green is off and will be covered by Ahmed Al Khathlan. Cissy Si on Orange is on long call and covers her own team. VACR consults will be seen by Cissy Si and attending Dr. Brook Watts. VA MICU 24 hour resident is Saurav Uppal VA Sat PM Resident is Eugene Chang VA Sat PM Intern is Jacob Aaron Sunday, March 26, 2017 Leanna Robertson on Blue is on long call and covers her own team. Rani Guttikonda on White is off and will be covered by Emad Mansoor. JaMia Washington on Green is off and will be covered by Ahmed Al Khathlan. Cissy Si on Orange is on medium call and covers her own team. VACR consults will be seen by Leanna Robertson and attending Dr. Atilla Nemeth.
UH Weekend Coverage
VA Weekend Coverage
Carpenter: Erica Lundgrin is off Sunday and will be covered by Mona Alotaibi. Dworken: Yasser Alsamman is off both days and will be covered by Tiffany Onger. Eckel: Carolyn Chan and Jordan Moran to arrange coverage amongst themselves. Hellerstein: Katia Khoury and Fahd Nadeem to arrange coverage amongst themselves. Naff: Rana E Sabbagh is off on Saturday and will be covered by JaMia Washington. Ratnoff: Shireen Khoury is covering his own team this weekend. Wearn: Timica Campbell is covering his own team this weekend. Weisman: Robin Zachariah is off on Saturday and will be covered by Marie-Noel Rahhal.
Friday, March 24th, 2017
NACR: Arun Iyer NF Residents: Fatima Fadlalla and Nicole Mongilardi NF Interns: Dana Diab and Hussain Khalid MICU Moonlighter: Leanna Robertson CICU Moonlighter: Tom Ladas Saturday, March 25th, 2017 NACR: Arun Iyer NF Residents: Fatima Fadlalla or Nicole Mongilardi NF Interns: Daniel Karb and Hussain Khalid UH Saturday NF Coverage: Tiffany George MICU Moonlighter: Amrita John CICU Moonlighter: Haytham Mously Sunday, March 26th, 2017 NACR: Arun Iyer NF Resident: Fatima Fadlalla or Nicole Mongilardi NF Interns: Daniel Karb and Hussain Khalid Senior Weekend Jeopardy: Vittal Hejjaji. Justin Morrison, Mona Alotaibi (Saturday), JaMia Washington (Sunday), Marie-Noel Rahhal (Sunday) Intern Weekend Jeopardy: Vincent Cruz, Kevin Kuo
UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER MARCH 24, 2017
MKSAP ANSWER
A – Brachioradial pruritus
This patient has brachioradial pruritus, a form of neuropathic itch that has been linked to abnormalities in the cervical spine. Inflammation or irritation of the appropriate cervical nerves causes recurrent and persistent itching in the upper extremities, usually on the forearms, but also, in some patients, around the neck, shoulders, and upper arms. A similar type of neuropathic itch occurs on the mid, medial back, called notalgia paresthetica. Evaluation of the spine may reveal evidence of osteoarthritis or other structural abnormalities; however, in the absence of gross neurologic deficits, surgery is unlikely to be of any benefit in managing this type of itch, so aggressive radiologic evaluation is generally not recommended.
Brachioradial pruritus is an “itch without a rash.” The itch usually has a deep, crawling, or tingling sensation. There are no primary skin findings, although the skin may be excoriated and even become lichenified and hyperpigmented from repeated scratching. A response to application of ice or cold packs is very characteristic and helps clinically confirm the diagnosis. A skin biopsy is nondiagnostic.
Because this is not a histamine-mediated itch, antihistamines and corticosteroids are usually unsuccessful in treating the itch. Topical analgesics, such as pramoxine, offer short-term relief. More prolonged relief may be gained with use of gabapentin or pregabalin in some patients.
Polymorphous light eruption (PMLE) is another skin condition in which patients develop skin lesions after exposure to sunlight. A variety of skin lesions may be seen in PMLE, including
urticarial wheals, papules, plaques, and vesicles. PMLE usually develops early in the spring, with
the first few exposures to sunlight, and can be triggered by intense exposures. Skin lesions, rather
than mere itch, are necessary for the diagnosis.
Prurigo nodularis is commonly known as “picker's nodules.” This condition can develop in itchy
skin (from whatever cause) and consists of thickened, lichenified, excoriated papules and nodules in
skin that has been repeatedly scratched.
Solar urticaria is another rare condition in which exposure to ultraviolet light causes hives. It can be
NEJM IMAGE CHALLENGE
A – Oleothorax
This patient had a history of pulmonary tuberculosis in the 1950s, and treatment at this time for this condition involved instillation of oil into the pleural space to collapse the involved lung. The oil was usually aspirated after the treatment was complete, which was usually a period of two years. In this case, the patient was lost to follow up after completing the treatment and the oil was left in place.
UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER MARCH 24, 2017
MEET THE INTERNS
Name: Yvonne Okereke Hometown: Union, NJ
Medical School: Rutgers New Jersey Medical School Current Rotation: CICU
1. What’s your favorite restaurant in
Cleveland? This is a tough one! I still have a lot to explore, but Pacific East was pretty good so I'll go with that for now.
2. Who would you want to be trapped in
an elevator with? Hahaha...I hope to never be trapped in an elevator to begin with, but if I had to choose, maybe Oprah Winfrey, Warren Buffet or Ellen--anybody who gives good advice and can help me pay off my med school loans, to be honest.
3. If you had one superpower, what would it be? Learning through osmosis would be pretty awesome; that counts as a super power right?
4. What musical instrument do you wish
you could play? The violin definitely. If I could pick up playing piano again, that would also be cool.
5. What is your go-to dance move?
Ah, the good old two step--never fails. I dabble in the occasional nae-nae from time to time, but only in the privacy of my own home or car, so as not to induce a panic. I've also been known to cut a rug back in my day with a pretty mean robot (more like set the rug on fire--that's what someone tried to do the last time that I broke out this show-stopper, can't imagine why).