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Prikvačeni tweet
Teaching Rounds Day 5/15 Fever. The Journey to a Diagnosis… Part 2 - Base Rate & The Spotlight Join us,
#medtwitter &#medstudenttwitterpic.twitter.com/zgN3phMvuy
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Rabih Geha proslijedio/la je Tweet
Oh just some board meeting prep while rocking your baby to sleep...
#wcw#GirlBoss@spekitapp@ellebowed#womenpic.twitter.com/7LizzHAZ4U – mjesto: Spaces Ballpark
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Rabih Geha proslijedio/la je Tweet
Resident to
@GStetsonMD in the hallway just now: "I just saw you and got super excited about teaching!" Twitter high-five, Geoff! cc:@gradydoctor@rabihmgeha@Gurpreet2015@DxRxEduHvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi -
What if this evaluation is unrevealing? Part 3 of the Fever Journey soon!
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Use the base rate to guide your initial approach. In most patients it will be these 6 infections. https://bit.ly/36Viecs Don’t move the spotlight in immunocompromised patients or returning travelers, expand it.pic.twitter.com/4hKIxbjyor
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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 conditionpic.twitter.com/X7TPEiobAu
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Fever in a returning traveler? Again, the spotlight expands, and does NOT shift. Check out this fantastic approach from
@EvelynSongMD and@DxRxEdu https://bit.ly/371FntV pic.twitter.com/TnDL6TGh9j
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Immunocompromised patients... Be careful. The spotlight doesn't SHIFT, it EXPANDS...pic.twitter.com/7LP5KIivYk
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There are two variables that can adjust the base rate ENOUGH... 1. The immune status 2. Travel history
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Wait. Wait. This base rate of being these 6 infections, does this apply to apply to all patients? Nope...
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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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These account for the overwhelming majority of infections we see.
@Sharminzi breaks them down here https://bit.ly/36Viecs pic.twitter.com/cZc7jIcIlq
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On day 1, we have to be open to these rare conditions, but the focus is on infection. What infections? The base rate (https://bit.ly/381tSnp ) would tell us to focus on 6 common sources.
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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 (
@Sharminzi has a great video https://bit.ly/37YNdG0 ) 5. Thyroid stormpic.twitter.com/Um8sSnQlxv
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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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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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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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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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There is an overwhelming list of causes of fever. A large number are virtually undiagnosable on day 1. Let’s talk about why.pic.twitter.com/kstSAODVLu
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Check out part 1 https://bit.ly/2OuQsNo 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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