Rabih Geha

@rabihmgeha

Internist + via . Host & team member . 🇱🇧 and 🇵🇰 roots.

San Francisco, CA
Vrijeme pridruživanja: srpanj 2012.

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  1. Prikvačeni tweet
    prije 9 sati

    Teaching Rounds Day 5/15 Fever. The Journey to a Diagnosis… Part 2 - Base Rate & The Spotlight Join us, &

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  2. proslijedio/la je Tweet
    prije 5 sati

    Oh just some board meeting prep while rocking your baby to sleep... – mjesto: Spaces Ballpark

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  3. proslijedio/la je Tweet
    prije 8 sati

    Resident to in the hallway just now: "I just saw you and got super excited about teaching!" Twitter high-five, Geoff! cc:

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  4. prije 9 sati

    What if this evaluation is unrevealing? Part 3 of the Fever Journey soon!

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  5. prije 9 sati

    Use the base rate to guide your initial approach. In most patients it will be these 6 infections. Don’t move the spotlight in immunocompromised patients or returning travelers, expand it.

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  6. prije 9 sati

    To summarize 1. Our task on day 1 in a patient w/ fever is to focus on infection; most autoimmune and cancers have to wait a bit. 2. Less commonly, the clinical context may suggest another day 1-diagnosable condition

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  7. prije 9 sati

    Fever in a returning traveler? Again, the spotlight expands, and does NOT shift. Check out this fantastic approach from and

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  8. prije 9 sati

    Immunocompromised patients... Be careful. The spotlight doesn't SHIFT, it EXPANDS...

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  9. prije 9 sati

    There are two variables that can adjust the base rate ENOUGH... 1. The immune status 2. Travel history

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  10. prije 9 sati

    Wait. Wait. This base rate of being these 6 infections, does this apply to apply to all patients? Nope...

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  11. prije 9 sati

    Common things are common. The base rate drives most of what we do. But not all of it... The clinical context occasionally overwhelms the base rate. If a patient presents with a high fever and a diffuse rash involving the face; move beyond the base rate and think Measles!!

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  12. prije 9 sati

    These account for the overwhelming majority of infections we see. breaks them down here

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  13. prije 9 sati

    On day 1, we have to be open to these rare conditions, but the focus is on infection. What infections? The base rate () would tell us to focus on 6 common sources.

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  14. prije 9 sati

    In addition to infection, are there other causes of fever that can be diagnosed on day 1? Yes! The clinical context may suggest 1. Drug/toxin 2. Heat shock 3. Blood transfusion reaction 4. A MAHA ( has a great video ) 5. Thyroid storm

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  15. prije 9 sati

    Why? Two rare reasons: 1. Infections can be the trigger for autoimmune diseases - HCV and cyro 2. Infections can trigger cancer too, and in some occasions, treating the infection can result in the malignant melting away - H. Pylori + MALT lymphoma Can you think of others?

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  16. prije 9 sati

    Why? Two common reasons: 1. Infections are often imminently treatable and can be morbid if not diagnosed promptly. 2. The treatment of most autoimmune diseases and malignancies - immunosuppression - may worsen an undiagnosed infection.

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  17. prije 9 sati

    Every patient with vasculitis probably needs blood cultures to rule out endocarditis. Make sure you assess for tuberculosis before diagnosing sarcoidosis. Even in patients with ESTABLISHED autoimmune or malignant conditions, a new fever resets the spotlight back on infection.

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  18. prije 9 sati

    A thorough exclusion of infection is a requirement for the diagnosis of a febrile autoimmune or malignant condition. Is this in the diagnostic criteria for these conditions? Often not, but it’s certainly implied.

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  19. prije 9 sati

    There is an overwhelming list of causes of fever. A large number are virtually undiagnosable on day 1. Let’s talk about why.

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  20. prije 9 sati

    Check out part 1 Key points: 1. Fever is specific to "inflammation", but not sensitive enough. An afebrile patient could be inflamed 2. Most, but not all, elevated temperatures represent a fever. Consider hyperthermia early. It could be life saving.

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