An Unusual Presentation in a Man of Advanced Age. Robert E. Richard

Transcription

1 An Unusual Presentation in a Man of Advanced Age Robert E. Richard

2 An Unusual Presentation by a Man of Advanced Age Robert E. Richard

3 A few observations on what ht makes aesaa good fellows eo sconference e ce Robert E. Richard

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5 University of Minnesota Active Learning with Powerpoint

6 Limit the kid pictures (make sure the kid is actually cute)

7 Mr GG is a 52 yo man with a PMH of CAD, DM, HTN, DSO, ABG, ASH, and MOUSE who presents to the ER with petechiae and gumbleeding of 8 hour duration. MEDS A whole bunch SOCIAL HISTORY: No birds or cats or dogs at home. Quit smoking 10 years ago after smoking1ppd x 20 years, doesn t drink alcohol l except a 6 pack of beer a day No allergies

8 Critique Take aet it easy with the eabbreviations at Simplify! Avoid it s a MAC/PC thing. Don t cram so much info on a slide its not readable. You only have ~20 to 25 minutes to talk! How many slides? 10, 20, 40? Your pointer is not a light saber!

9 What Font to Use Type size should be 18 points or larger: 18 point 20 point 24 point 28 point 36 point AVOID USING ALL CAPITAL LETTERS BECAUSE IT S MUCH HARDER TO READ * References can be in point font

10 Now its Time to discuss Drug induced thrombocytopenia Author James N George, MD Section Editor Lawrence LK Leung, MD Deputy Editor Stephen A Landaw, MD, PhD Last literature review version 18.2: May 2010 This topic last updated: June 24, 2009 (More) INTRODUCTION The clinician is frequently faced with the problem of a patient presenting with a low platelet count of uncertain cause. One important and reversible cause is drug induced thrombocytopenia. In most cases, thrombocytopenia is the only hematologic manifestation of drug toxicity. However, there are exceptions to this general rule: Heparin induced thrombocytopenia is associated with a hypercoagulable state and thrombosis rather than bleeding. (See "Heparin induced thrombocytopenia".) Some drug induceddisorders disorders, such as aplastic anemia and thrombotic thrombocytopenic purpura, result in thrombocytopeniaalongalong with other cytopenias as well as organ involvement. (See "Aplastic anemia: Pathogenesis; clinical manifestations; and diagnosis", section on 'Drugs' and"causes of thrombotic thrombocytopenic purpura hemolytic uremic syndrome in adults", section on 'Etiology'.) The pathogenesis and clinical management of patients with suspected drug induced thrombocytopenia will be reviewed here [1]. The diagnostic approach to the patient with thrombocytopenia is presented separately. (See "Approach to the adult patient with thrombocytopenia" and"evaluation and management of thrombocytopenia by primary care physicians".) MECHANISMS The usual mechanism of thrombocytopenia caused by drugs is accelerated platelet destruction caused by drug dependent antibodies. Following the observation that drug dependent antibodies bind to platelets via their Fab regions [2], subsequent studies have documented dthe various different mechanisms of drug dependent d d antibody formation [1,3]. Reversible drug binding to one of the major platelet surface glycoproteins (GP), most commonly GP Ib/V/IX or GP IIb/IIIa, can cause a protein conformational change [4]. This structural change results in the exposure of a neoepitope, expressed by a sequence normally concealed within the hydrophobic domains of the membrane protein. The molecular structure of the drug may itself become an integral part of the new antigenic epitope or, alternatively, the drug may increase the affinity of the antibody to the epitope [5]. In both cases, drug association with platelets is by noncovalent binding and the drugs are easily dissociated from platelets by in vitro washing procedures. Thus, demonstration of drug dependent dependentantibodies requires the continualpresence of the suspected drug during the reaction. The reversibility of binding of most drugs to platelets is distinct from the covalent binding of a few drugs (eg, penicillin) to the red cell membrane, which can then stimulate antibody formation via a hapten mechanism [1,6]. Antibody specificity Different drugs may provoke drug dependent antibodies

11 Now its time to discuss. What to do about UptoDate? Don t convert UptoDate to slides Good place to start and help in your organization Use the references and include them on your slides Know the topic

12 Lessons I ve learned (sometimes the hard way) Don t distract your audience at the end of your talk Questions are really important Respect your audience and target the right levell Copy someone s style you like Become an expert Propose questions or studies