11/16/21 morning report learning points!
1) Unexplained ascites can be from multiple intra-abdominal processes. Diagnostic paracentesis is the key first step (get at least 200cc if possible for cytology). Figures from Zach Gray! [1/4] 2) Omental nodularity with ascites on CTAP suggests peritoneal carcinomatosis: but consider mimics such as peritoneal TB, lymphoma, GIST, mesothelioma... and (in California) coccidioidomycosis. [2/4]
pubmed.ncbi.nlm.nih.gov/28203370/

AM report teaching points from today... with some help from many #formerchiefs!
1) CUP can be a diagnostic puzzle. @NCCN guidelines are an amazing place to start. Prioritize biopsying an accessible lesion, and stratify from there. [1/5]. 2) Some culprits include lymphoma, melanoma, sarcoma, germ cell tumors, and NETs, among others. Adenocarcinoma or SCC without clear primary may be treated by a combination of platinum agent + another agent (such as carboplatin + paclitaxel). [2/5]

Had a blast returning to in-person morning report at @VAPaloAlto! Some learning points: [1/5] 1. Strep intermedius can be normal oral flora, but can be very immunogenic and tends to form abscesses. See this excellent review in Frontiers! frontiersin.org/articles/10.33…
[2/5]