Hydroxyurea - Pathophysiology and Benefits in Sickle Cell Disease • Decreases number of pain crises ( 4.5 vs. 2.4) • Decreases hospitalizations (2.4 vs. 1) • Fewer ACS ( 35% vs. 24%) • Fewer transfusions Possible end organ benefit and decreased mortality #Hydroxyurea #Benefits #SickleCell #pathophysiology #pharmacology

Features of a Sickle Cell Crisis Sickle-cell disease - an autosomal recessive blood disorder. Characterized by red blood cells that adopt an abnormal, rigid, sickle shape. These cells can go on to block blood vessels leading to a "sickle cell crisis". Crises can be precipitated by a variety of factors and are usually associated with severe pain, lasting from 5-7 days. Sickle cell disease almost exclusively affects black individuals. The underlying pathophysiology of the crisis (4 different mechanism exist): 1) Vaso-ocdusion- Obstruction of capillaries leading to ischaemia. 2) Aplasia - Acute worsening of the baseline anaemia. Can be triggered by Parvovirus B 19, a virus that invades & destroys red blood cell precursors). 3) Splenic Sequestration - Major sequestration of sickle cells in the spleen. 4) Haemolysis - An accelerated drop in haemaglobin levels. (Accelerated red blood cell breakdown - more in patients with co-existent G6PD deficiency #SickleCell #Crisis #Features #Signs #Symptoms

Clinical Features and Complications of β-thalassaemia Major - Pallor - Jaundice - Bossing of the skull - Maxillary overgrowth - Splenomegaly and hepatomegaly - Need for repeated blood transfusions #BetaThalassaemia #Major #BThalassaemia #Signs #Symptoms #Diagnosis #Features

Differential Diagnosis - Fever of Unknown Origin (FUO) IMADE mnemonic: • Infection • Malignancy • Autoimmune (Rheumatologic) • Drug-induced • Everything else Dr. Uday Gulati @udaygulati #FUO #Fever #UnknownOrigin #Differential #Diagnosis #diagnosis #IMADE #mnemonic

Causes of Fever of Unknown Origin (FUO) - Differential Diagnosis Algorithm Neoplasm: • NHL • Hodgkin's lymphoma • Leukemia • Solid tumors Autoimmune: • SLE • Polyarteritis nodosum • Giant cell arteritis • Sarcoidosis Other: • Drug fever • Factitious fever • Trauma Non-infectious hepatitis • Recurrent PE Bacterial - Organ Specific Infection • Infectious endocarditis • Osteomyelitis • Occult abscess • Sinusitis • Cholangitis • UTI • Meningitis Bacterial - Non-organ specific • Brucellosis • Q-fever • Salmonella • Yersinia • Tuleremia • Septic Phlebitis • Rheumatic fever • Lyme disease • Whipple's disease Viral Infection: • HIV • EBV • CMV • Viral hepatitis • Enterovirus Other Infection: • Fungal • Protozoa (eg. malaria) • other parasites #Fever #UnknownOrigin #FUO #Chronic #Differential #Diagnosis #Algorithm #causes

Causes of Acute Onset Fever - Differential Diagnosis Algorithm Viral: • Rhinovirus • Influenza Virus • Parainfluenza Virus • Adenovirus • Enterovirus • Coronavirus • HIV Infectious - Other: • Fungal • Protozoa (eg.malaria) • Other parasites Bacteremia: • Intermittent Bacteremia • Continuous Bacteremia Septic Shock Acute Organ Specific Infection: • Upper Respiratory Tract Infection • Urinary Tract Infection • Pneumonia • Pyelonephritis • Meningitis • Skin Infection Abscess: • Head and neck • Thoracic • Abdominal • Pelvic • Extremity Inflammatory: • Thrombophlebitis • DVT • Pancreatitis Iatrogenic: • Transfusion reaction • Malignant Hyperthermia • Neuroleptic malignant syndrome Endocrine: • Thyroid storm • Acute Adrenal Insufficiency Non-Infectious Other: • Heat stroke • Sickle Cell disease • Drug fever #Fever #Acute #Differential #Diagnosis #Algorithm #causes

Pediatric Causes of Abdominal Pain Surgical: - Acute appendicitis - Intestinal obstruction including intussusception - Inguinal hernia - Peritonitis - Inflamed Meckel diverticulum - Pancreatitis - Trauma Medical: - Non-specific abdominal pain - Gastroenteritis - Urinary tract: • urinary tract infection • acute pyelonephritis • hydronephrosis • renal calculus - Henoch—Schönlein purpura - Diabetic ketoacidosis - Sickle cell disease - Hepatitis - Inflammatory bowel disease - Constipation - Recurrent abdominal pain of childhood - Gynaecological in pubertal females - Psychological - Lead poisoning - Acute porphyria (rare) - Unknown Extra-abdominal: - Upper respiratory tract infection - Lower lobe pneumonia - Torsion of the testis - Hip and spine #Abdominal #Pain #Pediatrics #Causes #Differential #Diagnosis #Peds

Differential diagnosis of acute abdominal pain based on pain localization #Diagnosis #AbdominalPain #Differential #RUQ #RLQ #LUQ #LLQ #Epigastric #Localization #Locations #Causes #Periumbilical

Abdominal Pain - Differential Diagnosis According to Localization of Abdominal Pain Abdominal pain can originate from intra-abdominal and extra-abdominal or non-GI conditions; hence, it’s advisable to be systematic in your approach to narrow down your differential diagnoses. (i.e., Cardiac, GI, infectious, hematologic, urologic, gynecologic, etc.) When diagnosing abdominal pain, the differential diagnoses can be based on anatomic localization of pain (Figure 3). This, in turn, helps direct your approach. An EP should prioritize possible life-threatening conditions in his differential diagnoses, and be mindful of other possible extra-abdominal causes attributable to abdominal pain (Table 2). Keep in mind that the following list of differentials is not exhaustive and should be correlated with the localization of abdominal pain (Figure 3). #Diagnosis #Differential #Abdominal #Pain #Location #Localization #Causes #Quadrants #Epigastric ** GrepMed Recommended Text: Evidence-Based Physical Diagnosis - https://amzn.to/361gAqL

Nephritic vs Nephrotic Syndrome Step 1: If the patient has hematuria and/or proteinuria, think about nephrotic/nephritic syndromes. Step 2: Does the patient have glomerular hematuria (RBC casts or dysmorphic RBCs in urine)? #Nephritic #Nephrotic #Syndrome #Comparison #Algorithm #Nephrology #Diagnosis