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UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER MARCH 3, 2017
VACR Corner By Dr. Will Garner
It’s that time of the month…the first Friday, and the easiest VACR corner. Not sure what to do tonight? Go to MIX at the Cleveland Museum of Art. If you are a member it’s free, otherwise the standard 15 bucks at the door. MIX: Vino “From Bacchanalian revels to Cubist tableaus to Goryeo celadon pitchers, wine and the history of art are inextricably linked. Celebrate this millennia-old libation with tastings in the atrium, wine-themed tours of the collection, and a live performance by Hot Djang! Featuring gypsy jazz”. Not sure who ‘Hot Djang! ’ is? Me neither. Apparently, it’s an acoustic jazz quintet featuring violin, clarinet, guitar and upright bass, inspired by the Parisian 1930s phenomenon known as gypsy jazz. Not sure what ‘gypsy jazz’ is? Me neither. So, come to mix and find out! All in all, this is essentially a can’t-miss event! Festivities start at 6PM and go to 10PM on Friday, March 3rd. See below for details: http://www.clevelandart.org/events/special-events/mix-at-cma http://clevelandmusicgroup.com/entertainment/hot-djang-gypsy-jazz/
Resident Newsletter UH Department of Internal Medicine Residency Program
Finally Friday
http://www.clevelandart.org/events/special-events/mix-at-cma
UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER MARCH 3, 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 Prashanth Thakker
Pager: 31529
Office: VA ext. 5034
VA CHIEF Jack Hornick
Pager: 31533
Office: VA ext. 5046
QUALITY CHIEF Jacob Sadik
Pager: 36644
Office: UH ext. 45806
UH CHIEF Carine BouAbboud Matta
Pager: 31250
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: Katia Khoury In VA primary care clinic, Katia saw an extra patient (not on her schedule) late in the afternoon Friday who had been waiting awhile. Thankfully, Katia was a great team player and agreed to see the patient even though she was done seeing the rest of her patients. To make matters more complicated, the patient was in decompensated heart failure and had to go the ED. Thank you for being a stellar team player, Katia! Your colleagues and patients thank you!
Please remember to submit your nominations for Resident of the Week to [email protected].
UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER MARCH 3, 2017
CANDY ROUNDS RETURNS!!!
THIS WEEK’S TOP CONTENDERS!
NAFF – 60 points (time 2:49)
VA GREEN – 60 points (time 2:55) CARPENTER – 60 points (time 2:59)
ECKEL – 60 points (time 3:00) DACRs – 50 points (time 2:04)
http://www.foodgatherers.org/?module=Page&sID=candybuyback
Great job everyone!!! NAFF TEAM, claim your Java Jive prize in the
UH chiefs office!
QUESTIONS & ANSWERS
1) This “box-car” shaped gram-positive bacillus produces a lethal toxin. Bacillus anthracis
2) Congenital pancreatic anomaly associated with recurrent pancreatitis. Pancreas divisum (also will accept annular pancreas)
3) Chemical compound which causes retinal toxicity in methanol poisoning. Formic acid
4) Most common bacterial etiology of otitis externa in immunocompetent patients. Pseudomonas aeruginosa
5) The SCOFF questionnaire screens for this psychiatric disorder. Eating disorder (accept anorexia nervosa or bulimia nervosa)
6) This Parkinson-plus syndrome is associated with distinctive eye findings Progressive supranuclear palsy
7) Which movie won the most Oscars in 2016? Mad Max: Fury Road
UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER MARCH 3, 2017
PICTURES OF THE WEEK
DID YOU KNOW: UH TRIVIA OF THE WEEK
Did you know that Claude Beck, founder of Beck’s triad (muffled heart sounds, hypotension, distended neck veins), utilized to recognize acute cardiac tamponade, was a professor of cadiac
surgery at CWRU/University Hospitals of Cleveland??
He also performed the first surgical treatment of coronary artery disease in 1935 as well as the first defibrillation using a machine he built with James Rand in 1947.
https://en.wikipedia.org/wiki/University_Hospitals_of_Cleveland
Welcome to the UH Family, Mallorie! Congratulations Michelle! We all can’t wait to meet her!
UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER MARCH 3, 2017
NEJM IMAGE CHALLENGE
MKSAP QUESTION OF THE WEEK
A 45-year-old woman is evaluated for severe hot flushes that significantly limit her quality of life as well as vaginal dryness that is controlled with local lubricants. She has a history of stage II, estrogen receptor -positive, progesterone receptor-positive, HER2-negative, invasive left breast cancer that was diagnosed 1 year ago for which she underwent lumpectomy and received chemotherapy and radiation therapy. She has not had a menstrual cycle since her fourth cycle of chemotherapy. She began taking tamoxifen 3 months ago after completing radiation therapy. She has tried non-pharmacologic interventions for hot flushes without any improvement. Physical examination is normal other than evidence of surgery on the left breast and radiation changes on her skin.
Which of the following is the most appropriate therapy for this patient?
A) Fluoxetine B) Low-dose estrogen-progesterone C) Red clover
D) Venlafaxine
A 65-year-old man presented with a recent history of weight loss, early satiety, mild flank pain, and this rash on his legs. CT scan revealed a mass in the head of the pancreas. Which neuroendocrine tumor is associated with this characteristic rash? A) Insulinoma B) Gastrinoma C) Glucagonoma D) Vasoactive intestinal peptide-secreting tumor (VIPoma) E) Somatostatinoma
UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER MARCH 3, 2017
UH CONFERENCE SCHEDULE
MONDAY, 3/6/17: Resident Morning Report 11:00 AM - 12:00 PM Noon Conference: 12:00 - 1:00 PM Dr. Katia Khoury Senior Grand Rounds Carpenter Room TUESDAY, 3/7/17: Intern Morning Report: 11:00 - 11:45 AM Grand Rounds: 12:00 - 1:00 PM Dr. Laleh Razavi-Nematollahi MD “Thyroid Disease in Pregancy” Kulas Auditorium
WEDNESDAY, 3/8/17: Resident Morning Report: 11:00 AM - 12:00 PM Noon Conference: 12:00 - 1:00 PM Dr. Constantine Tsigrelis Infectious Disease Carpenter Room THURSDAY, 3/9/17: Intern Morning Report: 11:00 AM – 12:00 PM Noon Conference: 12:00 - 1:00 PM Dr. Richard Grossberg Dr. Nathan Stehouwer Dr. Steven Strausbaugh Med/Peds Consults Panel Carpenter Room FRIDAY, 3/10/17: Resident Journal Club: 10:30 – 11:30 AM Morbidity & Mortality: 12:00 – 1:00 PM M&M Conference Kulas Auditorium
VA CONFERENCE SCHEDULE
MONDAY, 3/6/17: Noon Conference: 12:00 - 1:00 PM Dr. Charlie Lopresti Attending Rounds K119 TUESDAY, 3/7/17: Resident Morning Report: 10:00 - 11:00 AM Grand Rounds: 12:00 - 1:00 PM Dr. Laleh Razavi-Nematollahi MD “Thyroid Disease in Pregancy” K119 (live stream from UH) WEDNESDAY, 3/8/17: Resident Morning Report: 10:00 - 11:00 AM Morbidity & Mortality Conference: 12:00 - 1:00 PM M&M Conference K119 THURSDAY, 3/9/17: Intern Morning Report: 10:00 - 11:00 AM Noon Conference: 12:00 - 1:00 PM Dr. Amanda Clark Attending Rounds K119 FRIDAY, 3/10/17: Noon Conference: 12:00 - 1:00 PM Dr. Paul Coletta Senior Grand Rounds K119
CONTACT THE CHIEFS IF YOU HAVE ANY QUESTIONS OR CONCERNS!
UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER MARCH 3, 2017
Saturday, March 4th, 2017 Olapeju Olasokan on Blue is off and will be covered by Will Garner JP Lopes on White is on long call and covers his own team. Chris Peluso on Green is on medium call and covers his own team. Talib Dosani on Orange is off and will be covered by JaMia Washington VACR consults will be seen by JP Lopes and attending Dr. Jill Huded VA MICU 24 hour resident is Rana ElSabbagh VA Sat PM Resident is Catherine Myers VA Sat PM Intern is Faisal Almayman Sunday, March 5th, 2017 Olapeju Olasokan on Blue is off and will be covered by Will Garner JP Lopes on White is on medium call and covers his own team. Chris Peluso on Green is off and will be covered by JaMia Washington Talib Dosani on Orange is on long call and covers her own team. VACR consults will be seen by Talib Dosani and attending Dr. Sarah Augustine
UH Weekend Coverage
VA Weekend Coverage
Carpenter: Christina Guzman is covering her own team this weekend. Dworken: Mohannad Abou Saleh is off Sunday and will be covered by Leben Tefera. Eckel: Greg Nizialek and Saurav Uppal to arrange coverage amongst themselves. Hellerstein: Scott Yasinow and Toral Patel to arrange coverage amongst themselves. Naff: Jennifer Kraninger is off both days and will be covered by Vittal Hejjaji. Ratnoff: Marie-Noel Rahhal is off on Saturday and will be covered by Leben Tefera. Wearn: Erica Giraldi is off on Saturday and will be covered by Nissreen Elfadawy. Weisman: Timica Campbell is off both days and will be covered by Paul Lin.
Friday, March 3rd, 2017
NACR: Katia Khoury NF Residents: Ben Alencherry and Sagarika Satyavada NF Interns: Daniel Kobe and Husna Siddiqui MICU Moonlighter: Megan Chan CICU Moonlighter: Haytham Mously Saturday, March 4th, 2017 NACR: Namrata Patel NF Residents: Ben Alencherry and Sagarika Satyavada NF Interns: Daniel Kobe and Husna Siddiqui UH Saturday NF Coverage: Akiva Diamond MICU Moonlighter: Amanda Pensiero CICU Moonlighter: Haytham Mously Sunday, March 5th, 2017 NACR: Namrata Patel NF Resident: Ben Alencherry or Sagarika Satyavada NF Interns: Husna Siddiqui and Saleh Alhasan Senior Weekend Jeopardy: Fahd Nadeem, Ahmed Al Khathlan, Peter Volpe, Nissreen Elfadawy (Sunday) Intern Weekend Jeopardy: Matthew Wright, Jessica Oh
UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER MARCH 3, 2017
MKSAP ANSWER
D – Venlafaxine
The most appropriate pharmacologic intervention is venlafaxine. Many women experience amenorrhea with chemotherapy, and this sudden change is often associated with disabling menopausal symptoms. Tamoxifen also causes hot flushes. Tamoxifen must be converted to its active metabolite, endoxifen, through CYP2D6 metabolism. For women in whom estrogen-progesterone replacement therapy is contraindicated, there are modest data suggesting some benefit from antidepressants (SSRIs, the serotonin-norepinephrine reuptake inhibitor venlafaxine) and gabapentin. Some antidepressants such as paroxetine and fluoxetine are moderate to strong inhibitors of CYP2D6. The effect of these drugs in combination with tamoxifen on breast cancer recurrence or survival is unknown. Therefore, patients receiving tamoxifen should be treated with
drugs such as venlafaxine or gabapentin that are least likely to inhibit tamoxifen.
Hormone replacement therapy with estrogen-progesterone is worth considering in nonsmokers without other significant cardiovascular risks, a history of thromboembolic disease, a personal history of breast cancer, or a first-degree relative with breast cancer. Hormone replacement therapy is contraindicated in women with hormone receptor-positive breast cancer. Additionally, this patient's risk for venous thromboembolism would be even higher with concomitant tamoxifen and
hormone replacement therapy.
Insufficient evidence currently exists demonstrating the effectiveness of physical exercise or herbal remedies, such as soy proteins, black cohosh, red clover, dong quai, evening primrose, or ginseng, in relieving menopausal symptoms.
NEJM IMAGE CHALLENGE
C – Glucagonoma The correct answer is glucagonoma. In addition to the above symptoms, the patient had noted worsening glycemic control in his previously diagnosed type 2 diabetes, and was found to have a serum glucose level of 982 mg per deciliter on presentation. This rash, also called necrolytic migratory erythema, is strongly associated with glucagonomas, rare neuroendocrine tumors that can also cause weight loss and worsening glucose intolerance.
UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER MARCH 3, 2017
MEET THE INTERNS
Name: Mohammed Wazzan
Hometown: Jeddah Saudi Arabia
Medical School: King Abdulaziz University
Current Rotation: Hellerstein
1. If you could be any Disney character which one would you be? And Why? Timon and Pumba because they live by the “Hakuna Matata” concept.
2. What is the coolest internal organ?
And why? The liver is one of the most complex organs it the body. You dialyze a kidney and pump a heart, but nothing can replace the liver except for another liver.
3. Where would you go for your ideal
vacation? Hawaii, relaxing on the beach
4. If you had time, what is the next
Netflix, Hulu, Amazon, or cable show that you would binge on? Viking. It is based on a real story and I love it!
5. What's your favorite restaurant in
Cleveland? Boiling Seafood Crawfish - they serve seafood in a big bag. You should eat straight from the bag - it is a cool experience!
