A few misc pearls:
- In the outpatient world, when you see acute issues repeatedly, consider: does the patient need to go to the ED for expedited eval? Or early f/u? Expedited specialty referrals?
- For HSV, Valtrex is most helpful for symptoms in the first 72 hours
- Crohn’s classically has “skip lesions” and has transmural inflammation on pathology. Can involve the entire GI tract from mouth to perianal area. Remember extraintestinal manifestations as well (including eye, skin, joints!)
- UC classically starts in the rectum, extending proximally in a continuous and circumferential pattern. Biopsies show crypt abscesses.
- Thanks to Micki for sharing a few OBGYN pearls:
- If you are concerned about genital HSV, do a pelvic exam and look for cervical vesicles too!
- Young women with persistent tachycardia is concerning. It takes a lot to become tachycardic, and they can maintain hemodynamic stability for a long time!
Hand foot mouth disease (HFMD)
- Epi: commonly in young children (<5-7yo) but can be seen in adults; commonly in summer and early fall but can occur anytime.
- Transmission: fecal-oral
- Microbiology: coxsackie, echovirus, and enterovirus
- Clinical presentation: low-grade fevers (<38.3oC), oral lesions usually in isolation, begin as macules then progress to vesicles then superficial painful ulcers
- But there is also atypical HFMD with a specific coxsackievirus A6 genotype – more severe: higher fevers, wider distribution of lesions, longer duration
- Diagnosis: clinical diagnosis
- If need confirmation, can perform PCR/cx on throat, stool and vesicular fluid samples
- Treatment: supportive
- Complications: poor po from oral pain leading to dehydration, viral “aseptic” meningoencephalitis, myocarditis, conjunctival ulceration
- Epi: very rare! Often in 20-40yo, most common in east Asia, Mediterranean areas, lower prevalence in North America and Europe
- Rare vasculitic disease, can affect small, medium and large vessels – both arteries and veins!
- Diagnosis of exclusion! There are criteria for diagnosis, primarily used for research:
- Oral ulcers – at least 3x in 12 mos
- Any 2 of the following
- Recurrent genital sores/ulcers
- Uveitis or retinal vasculitis
- Characteristic skin lesions – erythema nodosum, pseudofolliculitis, papulopustular lesions, acneiform nodules
- Positive pathergy test (though can be negative in some patients!)
- What is this?! A prick in the forearm with a small gauge needle à test is positive if there is a small red bump or pustule 24-48h after the prick!
- Interestingly, renal and peripheral nervous system involvement is rare!
- Treatment: ibuprofen, colchicine, steroids, immunomodulators
- Complications to be on the lookout for: pulmonary artery aneurysms, vascular thrombosis
- A short handout is attached!