Where All Can You Do a Poster Presentation for Internal Medicine and Family Medicine in Us

OHSU Internal Medicine Resident Clinical and Research Abstract Presentations

American College of Physicians Oregon Chapter Scientific Meeting

November 2016 ~ Salem, Oregon

Winners

Oral Vignettes

Get-go identify--Jeffrey Bien, "On Booby Traps and Burner Telephone"
2d place--Curtis Lachowiez, "Breaking the Case, By Breaking the Blood"

Quality Improvement Posters

Start place--Suvi Neukam, "Slippery When Wet: Cleaning Upward The Fluid Assistants Order Menu By Combine Principals of Usability Testing and Improvement Science"
Second place--Molly Andreason, "Redesigning Care Transitions: Standardizing Interprofessional Discharge Process at VA Portland Healthcare System"

Loftier Value Toll Conscious Care Posters

Kickoff place--Bethany Roy, "The Use Of CPTA In ED And Inpatient Settings For Evaluation Of PE: Are We Choosing Wisely?"

Oral Presentations

On Booby Traps and Burner Phones
Jeffrey Bien, Md
Faculty mentor: Claire Zeigler, MD, MPH
Susac's Syndrome is a rare neurologic disorder which can present as late-onset paranoia and psychosis.  Given its rarity and nonspecific constellation of symptoms, it can exist difficult to recognize in primary intendance settings.

Breaking the Case, past Breaking the Blood
Curtis Lachowiez, MD
Faculty mentor: Gabrielle Meyers, Physician
Fanconi Anemia is a rare congenital os marrow failure syndrome typically presenting clinically in childhood, associated with certain physical, hematologic, and neoplastic atmospheric condition. Cases rarely take asubtler presentation without these classical features, thus requiring a loftier index of suspicion when because the diagnosis. Prompt recognition is imperative.

Clinical Vignette Posters

Bilateral Renal Artery Dissections from Segmental Arterial Mediolysis: A Rare Presentation of a Rare Status
Molly Andreason, MD
Segmental arterial mediolysis (SAM) is a rare non-inflammatory, non-atherosclerotic arteriopathyinvolving lysis of the smoothen muscle of the outer media wall, normally involving visceral abdominal arteries. Information technology can take variable presentation based on the arteries involved, only requires promptrecognition as it carries high mortality upon presentation due to risk of astute rupture and hemorrhage.

The Folly of Following Your Middle: A Case of Late Onset Inflammatory Bowel Affliction
Jane Babiarz, MD
The diagnosis of inflammatory bowel illness is ofttimes delayed in the elderly due to subtlety of abdominalsymptoms and prevalence of comorbidities with similar presentations.

Subconscious in Plain Sight: False Reassurances Obscuring a Case of Intravascular Lymphoma
Jeffrey Bien, Dr.; Renee Honeyfield, MD
Kinesthesia mentor: Jonathan Pak, MD
​A patient with progressively worsening constitutional symptoms, profound weakness, elevated inflammatory markers, anemia and inexplicable shock physiology is establish to accept extensive organ involvement from intravascular lymphoma.

Treating Chronic Hurting in a Rapid-Metabolizer
Stephen Cohen, MD
This case illustrates the difficulty of diagnosing opioid rapid metabolizers and the potential benefit of switching these patients off of opiates.  Using objective lab data in conjunction with the expert opinionsof a multidisciplinary group allowed us to diagnose the patient every bit a rapid-metabolizer.

IVIG HITs the Spot
Jessica Dreicer, MD; Jason Shatzel, Medico
Kinesthesia mentors: André Mansoor, Doc; Ximena Levander, Physician
Even later heparin exposure ceased, this patient had persistent thrombocytopenia suggesting a possible autoimmune pathophysiology.  Perhaps this explains the success in treating with IVIG, despite the fact that it is not recommended as treatment in typical Hitting.  The success of using IVIG in this case too as previously reported cases raises the prospect of efficacy in this subgroup of patients with HIT and highlights the need for additional research in this area.  Additionally increasing awareness of atypical Striking is imperative as heparin products are often reflexively given to these patients and thus re-exposure is likely pathologic.

Water, Water, Everywhere, just non a Drop in the Vasculature: A Case of Systemic Capillary Leak Syndrome
Kristy Duggan, Dr.
Kinesthesia mentors: Sima Desai, Doctor; Tom DeLoughery, Medico
The rare disorder, Systemic Capillary Leak Syndrome (SCLS), should exist considered in the patient plant to take the triad of severe hypotension, hypoalbuminemia, and hemoconcentration.

Nether Pressure:  Anchoring, Ultrasound, and Cardiac Tamponade
Daniel Green, MD, MPH

Faculty mentor: Daniel Toms, MD
Diagnostic errors are a major and underappreciated correspondent to the gap in quality health care delivery.  Anchoring bias is a mutual cognitive bias that over emphasizes the initial information despite new information that is contrary. Wards teams are at risk of making diagnostic errors due to anchoring bias when receiving paw off of newly admitted patients from ED physicians. When patients don't fit into an illness script, or conceptual frame piece of work for a chief complaint, farther work up and thought is necessary.

The Eyes Have Information technology:  An Unusual Instance Of Blurry Vision
Daniel Guy, Md
Faculty mentor: Khaled Tolba, MBBS
Blurry vision is a common medical complaint that is often times obscure to the internal medicine provider. We nowadays an unusual crusade for blurry vision.  A thorough review of systems may exist suggestive of systemic causes of blurry vision.

Y'all Are What You Eat-Your Lab Values Are What Yous Potable:  An Unusual Etiology Of Pleural Effusion
Daniel Guy, Dr.
Faculty mentor: Avital O'Glasser, MD
Boerhaave syndrome is a term used to describe esophageal perforation which occurs due to vomiting.  This is usually a full-thickness tear in the esophageal wall due to sudden increment in intra-esophageal pressure level combined with relatively negative intra-thoracic pressure acquired by airsickness. In this case the patient had a prior caustic ingestion leading to a long esophageal stricture and predisposing him for esophageal rupture.

Traveling Arthralgias In A Returning Traveler
Richie Hegarty, MD
Faculty mentor: Avital O'Glasser, Dr.
​This case illustrates that the differential diagnosis of arthralgias in a returning traveler is very broad and includes both exotic infectious etiologies likewise equally weather condition unrelated to travel history. This patient complained of numerous nonspecific symptoms but the combination of arthralgias, enthesitis, and possible uveitis the onset of which followed a discrete GI affliction in the setting of a family history of spondyloarthropathies makes reactive arthritis the most probable diagnosis.

The Curious Example of Subcutaneous Sarcoidosis
Meagan Herda, MD
Sarcoidosis is a relatively common condition with a multifariousness of clinical manifestations. Although as many as 25% of patients with sarcoidosis accept skin findings, it is far less common for a patient to initially nowadays with subcutaneous sarcoidosis.

A Dropsical Diagnosis
Evthokia Hobbs, MD
Resident co-writer: Ann Perrin, Medico
​Kinesthesia mentor: Tim Kerrigan, Md; Shona Hunsaker, Doctor
Out of the many causes of exudative ascites, hypothyroidism is among the least documented.  We nowadays a case of myxedema ascites diagnosed in a patient with end stage renal affliction (ESRD) secondary to polycystic kidney disease.

A Painful Syncope – Glossopharyngeal Neuralgia
Brianna Ketterer, Dr.
Head and neck cancers can be associated with syncope and pain in and of themselves. However, there is a rare disorder of the ninth cranial nervus chosen glossopharyngeal neuralgia in which paroxysms of severe pain are associated with excessive vagal outflow resulting in bradycardia, hypotension, syncope and even cardiac arrest.

C'est La Vie… de la Valve
Milla Kviatkovsky, Practice, MPH; Meryl Paul, Doctor; Luke Yeager
Faculty mentor: Avital O'Glasser, Medico
When a patient does not improve with initial treatment, we must distinguish between treatment failures versus diagnostic mishaps. Cognitive biases of anchoring and status quo perhaps favor the treatment failure choice, however we must re-visit our diagnostic tests, to evaluate their sensitivity in ruling out alternative etiologies.

What is green on the inside and yellow on the outside?
Milla Kviatkovsky, Practice, MPH; Meryl Paul, Doc
Faculty mentor: Avital O'Glasser, Physician
Pressure to obtain an platonic body image in today's lodge frequently drives both men and women to seek supplements for functioning enhancement and weight loss. These supplements are readily available both online and in stores with no FDA regulation. Despite the perception that products sold in major Usa stores are safe, clinicians treating the consequences thereof know amend.

Anchors Aweigh! Catecholamine Surge Bearded as Postpartum Feet
Sarah Larsen, MD
While feet during pregnancy and post-partum is common, in rare circumstances, it may be a manifestation of pheochromocytoma, where the consequences of missing the diagnosis may be grave.

Complications of Primary Varicella Zoster Virus in Adults
Melissa LeBlanc, MD

Faculty mentor: Joe Chiovaro, MD
Varicella-zoster virus (VZV) presents in two forms, main infection (chicken pox) and zoster(shingles).  The majority of primary cases are seen in children and are self-limited and treated symptomatically. In adults, there is increased run a risk of complications including pneumonitis, hepatitis, encephalitis/meningitis and secondary bacterial infections, which are more commonly seen in immunocompromised persons. We present the example of a previously healthy man presenting with diffuse rash.

Diagnosis Under Force per unit area:  Peripheral T-Jail cell Lymphoma as An Elusive Cause of Progressive Eosinophilic Myocarditis
Dylan Mart, Medico; Jacob Luty, MD
Kinesthesia mentor: Rebecca Harrison, Medico; Cristina Fuss, MD
Eosinophilic myocarditis (EM) is a rare crusade of progressive myocardial dysfunction that has a broad array of inciting diseases and many distinct complications. An elusive crusade of EM is peripheral T-jail cell lymphoma (PTCL), a protean entity with varied presentations. We present a case of PTCL that defied diagnosis, stressing the importance of a wide differential for causes of EM.

When the Cure Becomes the Cause: A Instance of Mail-Amoxicillin Aseptic Meningitis
Suvi Neukam, Practice; Anushka Shenoy
Kinesthesia mentor: Stephen Mehanni, MD
Aseptic meningitis is inflammation of the meninges not caused by traditional bacterial infections. A misnomer, the most common etiologies of aseptic meningitis include viral infections and atypical bacterial infections.  Although less established in the literature medication induced aseptic meningitis of increasing relevance.  Most ordinarily drug-induced aseptic meningitis (DIAM) occurs secondary to exposure to NSAIDs, only causality from other medications is possible. Hither we present the 9th known case of amoxicillin induced aseptic meningitis (AIAM) and first case reporting focal deficits that presented post-cessation of amoxicillin.

A Case of "Thrombotic Storm"
Sven Olson, MD
Faculty mentor: André Mansoor, Doc
​Malignancy is a well-known cause of venous thromboembolism (VTE). Rarely, malignancy tin can precipitate a severe thrombotic phenotype known as the "thrombotic storm."  Though treatment of malignancy eliminates the associated thrombophilia, this depends on proper identification of a principal tumor, which is sometimes easier said than washed.

Dissecting the Workup for Syncope
Mario Padilla, Doc
Faculty mentor: Kevin Piro, Dr.
Syncope is a common presenting symptom for admission to a medicine ward. It has abroad differential, including diagnoses which are emergencies. The work upward is besides part of the Choosing Wisely campaign because it can include unnecessary and low yield testing.

When Neck Deep in Scarlet Herrings, Have a Deep Breath
Meryl Paul, Physician; Milla Kviatkovsky, DO, MPH; Luke Yeager
Kinesthesia mentor: Avital O'Glasser, Doc
​Dyspnea is a common complaint for which patients seek medical attention; it carries pregnant morbidity, both psychologically and somatically. In approaching its broad differential, the astute clinician must wade through numerous data points, keeping in heed that all that wheezes is non reactive airway disease.

A Veritable Vascular Quandary
Christopher Purtell, MD
Faculty mentor: Kyle Kent, MD
​The diverse elements of mimicry that can occur with a vasculitis process must be weighed carefully in approaching a final diagnosis, oftentimes requiring an extensive workup and close follow-up.

Rituximab for the management of severe recurrent granulomatosis with polyangiitis
Bethany Roy, MD
Faculty mentors: Akram Khan, MD; Anjay Wanchu, Doc
Granulomatosis with polyangiitis (GPA) is a small-vessel, immune-mediated vasculitis associated with increased production of autoantibodies known equally anti-neutrophil cytoplasmic antibodies (ANCA). Prior to the availability of immunosuppressive therapy, the bloodshed rate of ANCA-associated vasculitis was virtually 100%. Now, these vasculitides can be treated with induction therapy followed past maintenance therapy once remission is accomplished. Traditionally, the gold standard for induction and maintenance was cyclophosphamide in combination with high-dose corticosteroids. However, relapse rates on this regimen can be as high as l% and chronic cyclophosphamide is associated with a significant risk of toxicity.  This example describes the use of rituximab for consecration and maintenance in a patient with severe, recurrent GPA.

Subliminal and Trigeminal—A Case of Trigeminal Neuralgia every bit the Initial Manifestation of Leptomeningeal Carcinomatosis
Carlton Scharman, Medico
Faculty mentor: Ximena Levander, Md
Leptomeningeal carcinomatosis (LMC) is an uncommon form of solid tumor metastasis nearly associated with cancers of the lung and breast. Rarely, is LMC the initial manifestation of these cancers, and do to non-specific symptoms tin can make diagnosis challenging. Presented here is a example of trigeminal neuralgia due to LMC equally the initial manifestation of non-modest-prison cell lung cancer (NSCLC).

Way Off From Korsakoff – A Case of Confabulation due to Inductive Communicating Artery Aneurysm Rupture
Carlton Scharman, MD; Wendy Tseng, Medico
Faculty mentor: Avital O'Glasser, MD
Although many definitions exist, confabulation can be described as the compensation for memory loss by the verbal production of erroneous and fabricated material without the desire to mislead. Although confabulation is classically associated with Wernicke-Korsakoff syndrome, the differential diagnosis is much wider than 1 may wait. This is case of confabulation as a sequela of a ruptured inductive communicating avenue (ACoA) aneurysm.

The Boo-Boo that Wouldn't Go Farewell-Bye
Amy Semritc, Dr.
Kinesthesia mentor: Drew Oehler, MD
Skin and soft tissue infections are a common clinical entity treated by the general internist in both the inpatient and outpatient settings. Having a broad differential diagnosis and avoiding anchoring or availability bias are important when ane or more features of the patient'due south presentation do not fully align with the diagnosis.

Shoulder Pain as a Harbinger of Rectal Cancer
Anil Sharma, Doctor
Faculty mentor: Carrie Sailer, MD
The initial evaluation of shoulder pain includes consideration of a variety of intrinsic and extrinsic etiologies.  At times, at that place can be red flag signs and symptoms that suggest the interest of systemic pathologies.  Distal osseous metastases tin be associated with colorectal cancer; thus shoulder pain with bony lesions should raise an index of suspicion for malignancy.

A Real Pain in the Neck
Kelsey Shaver, Physician
Kinesthesia mentor: Kyle Kent, MD
Benign recurrent aseptic meningitis or "Mollaret's meningitis" named after the French neurologist Pierre Mollaret who kickoff described the syndrome, is a rare benign form of painful meningitis in which patients have recurrent episodes that oftentimes resolve spontaneously.   The majority of these cases are secondary to canker simplex virus type 2 (HSV2).  This clinical vignette highlights the controversy of suppressive antiviral therapy in patients with benign recurrent aseptic meningitis.

An Singular Presentation of a Mutual Disease
Lucy Shi, Doc, Casey Luce
Faculty mentor: André Mansoor, Physician
Chest wall masses are uncommon and underlying causes are primarily neoplastic or infectious. Thelikelihood of infection is increased in patients with a history of intravenous (IV) drug abuse and immunocompromised state. Of the chest wall masses that are neoplastic, the near common causes in adults include metastasis, local invasion of an underlying next tumor, benign tumor, chondrosarcoma and lymphoma.

Fevers, Fasciculations, Hallucinations…F.U.Oh My!
Lucy Shi, MD
Faculty mentor: Avital O'Glasser, MD
Fever of unknown origin (FUO) is a clinically defined condition with distinct criteria. The term is ofttimes used for syndromes that exercise non meet this exact description, but truthful FUO remains uncommon. Upward to 50% of FUOs are from an unidentified etiology. In patients who remain undiagnosed after half-dozen months, it becomes unlikely a diagnosis will always be found.

Expect the Unexpected: An Singular Cause of Fatigue in the Elderly
Emilio Sulpizio, MD; Christopher Fine, Md
Faculty mentor: Sima Desai, Dr.
Fatigue is a common complaint in the elderly and is often speedily attributed to normal aging or possible malignancy. We present a case of a previously active elderly woman with hypertension and asthma who adult subacute progressive severe fatigue leading to being bed-bound over i calendar month.

In the Glow of a Coma
Wendy Tseng, MD
Faculty mentor: Matthew Drake, MD
Ethylene glycol is a rare, but potentially fatal cause of anion gap metabolic acidosis. While we take classically been taught the MUDPILES approach to anion gap acidosis, call up of ethylene glycol as the "E"in the algorithm can be delayed due to infrequency of cases. Prompt recognition and handling of ethylene glycol poisoning, however, is essential for preventing morbidity and bloodshed.

Acute Management of Severe Hypertriglyceridemia
Garrett Waagmeester, MD; Deron Amador, MD
Kinesthesia mentor: Kate Mackey, Doctor; James Lundblad, Md
Eruptive xanthomas are associated with principal dyslipidemia disorders as well as secondary causes of hypertriglyceridemia due to underlying medical atmospheric condition or medications. Acute direction involves lowering triglycerides to prevent acute pancreatitis. Long-term therapies focus on risk factor reduction through lifestyle modification and management of chronic medical conditions.

SAPHO:  A Case of Peel and Bones
Teena Xu, Doctor
Faculty mentor: Cong-Qiu Chu, Md
​SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome is a chronic, relapsing inflammatory disease involving the pare, bones, and joints. It is a rare syndrome involving a constellation of common symptoms that requires high clinical suspicion to unify the diagnosis.

Clinical Research Posters

Mortality Gamble Factors Among Those with Peripheral Arterial Disease
Stephen Amrock, MD, SM
Faculty mentor: Michael Shapiro, Medico
Rates of peripheral arterial illness (PAD), a leading cause of atherosclerotic cardiovascularmorbidity, proceed to increase. Traditional cardiovascular hazard factors are implicated in thedevelopment of PAD, withal the extent to which such risk factors correlate with mortality in suchpatients, and how clinicians ought to prioritize secondary prevention, remains insufficiently assessed

Quality Improvement Posters

Redesigning Care Transitions: Standardizing the Interprofessional Belch Procedure at the VA Portland Healthcare Organization (VAPORHCS)
Molly Andreason, Doc; Megan Molleck, Physician; Jean Liew, Doctor; Kelsey Shaver, MD; Jeff Dueker, Doctor
Faculty mentors: Matthew DiVeronica, MD; Renee Segura, Medico; Shona Hunsaker, MD
Communication of transitional care needs between inpatient and outpatient settings isfacilitated primarily past discharge documentation, with increased hazard of errors by unclear orincomplete documentation. Standardized belch documentation can meliorate the safety ofcare transitions. In a review of 100 randomly selected patients discharged from the medicineservice at the VAPORHCS from July 2013 to June 2014, discharge documentation lacked areconciled medication list (41%), articulate depiction of follow-up intendance responsibility (54%) and acomplete list of mail-discharge follow-up appointment needs (46%).  Follow-upward care needs werenot completed 40% of the time. We created a standardized, interprofessional discharge processat VAPORHCS to ameliorate provider communication and increase patient appointment across thecare transition.

Finding a Voice for the Voiceless: A Housestaff-Led Initiative to Facilitate Advance Care Planning Through Documentation of Surrogate Decision Maker in the Electronic Medical Record
Alex Perry, Md; Jake Luty, Md; Jeffrey Dueker, MD
​Kinesthesia mentor: Matthew DiVeronica, Doc
Accelerate intendance planning (ACP) is a difficult but powerful step toward preserving patient autonomyin clinical situations in which the patient may not be able to participate in decision making oftheir dispensary care. Identification of a surrogate determination maker was identified as a vital piece ofACP and thus preserving patient  autonomy.Kickoff in Baronial 2015, the Housestaff Qualityand Safety Council (HQSC) at OHSU, led a hospital-‐‐wide initiative to increase rates ofdocumentation of patients' SDMs to xl% of all developed, not-‐‐observation, non-‐‐psychiatric patientsadmitted by April 2016. This work was initiated in cooperation with the Caring Wisely team, aninstitution-‐‐prioritized workgroup focused on improving ACP. The completion of this goalconnected to a retirement bonus for all housestaff.

Glace When Wet:  Cleaning Up the Fluid Administration Order Menu past Combining Principles of Usability Testing and Improvement Science
Suvi Neukam, Medico; Charles DeDeaux, Doc
Kinesthesia mentor: Renee Segura, MD
Usability testing is a method of quality improvement that assesses the ability of a organisation toallow its users to carry out tasks safely, effectively, efficiently and enjoyably (1). In this projectwe depict the office of usability testing in improving an intravenous fluids (IVF) ordering menu and in doing so demonstrate that usability testing is a viable and effective method for residents to engage in quality improvement efforts.

A "Surprising" Approach to Avant-garde Care Planning Rounds at the VA Portland Wellness Care Organisation
Linda Wang, Doc; Megan Moody, Doc; Sarah Larsen, MD; Maria Peila, MD; Emma Peiris, Doc; Jeff Dueker, Dr.
Kinesthesia mentors: Matthew DiVeronica, MD; Renee Segura, MD; Shona Hunsaker, MD
Physicians overestimate life expectancy even in terminally ill patients and this discomfort withprognostication is ane of many barriers that can delay avant-garde intendance planning (ACP) discussions.Local palliative care experts suggest approaching ACP as a continuum may help providers andpatients engage in these conversations earlier and more often. Previous investigation revealedone yr mail hospital belch bloodshed rates for VAPORHCS betwixt 2010 and 2013 rangedfrom sixteen.1-‐‐18.ii%.  In a random sample of 100 patients discharged from medicine in 2013 whodied within one year of belch, rates of POLST completion and palliative care or hospiceconsultation were 26%, 11%, and ix% respectively. Comparison the one year bloodshed rate withour rates of POLST completion and expert consultation highlights the gap in ACP needs.

Loftier Value Toll Conscious Care Posters

The Utilise of CTPA in ED and Inpatient Settings for Evaluation of PE: Are we Choosing Wisely?
Bethany Roy, MD; Jacob Nelson, MD; Sven Olson, Md; Alex Perry, MD; Jeffrey Dueker, MD
Faculty mentor: Matthew DiVeronica, Dr.; Shona Hunsaker, MD; Renee Segura, Md
An ACP Choosing Wisely initiative is to obtain a D-dimer measurement every bit the initial diagnostictest in patients with low pretest probability of pulmonary embolism (PE) earlier imaging studies.The combination of a low-probability Wells score and negative D-dimer makes PE unlikely.Withal oft, the initial test for evaluation of PE is CT pulmonary angiography (CTPA) without consistent documentation of PE risk, potentially exposing patients to unnecessary harms and costs. The objective of this retrospective chart review is to assess the utilization of CTPA in patients with low pretest probability of PE.

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Source: https://www.ohsu.edu/school-of-medicine/medicine/2016-oregon-acp-virtual-poster-session

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