#249 Tales from the Curbside: Vulvovaginitis, Cellulitis, Bites, MGUS, SPEP

January 4, 2021 | By Matthew Watto, MD

Summary

Recap the top pearls from recent shows on vulvovaginitis, cellulitis and bites, MGUS and the SPEP. Tales from the Curbside (TFTC) is pilot project providing a rapid review of recent Curbsiders episodes.

Note: There is no CME for this mini-episode but visit curbsiders.vcuhealth.org to claim credit for #244, #246 and #247. 

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Credits

• Written, Produced and Hosted by: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP  
• Infographics by: Kate Grant MBChb, MRCGP, Beth Garbitelli and Nora Taranto MD
• Cover Art: Matthew Watto
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com

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Time Stamps*

*Note: Time Stamps refer to ad free versions. 

• 00:00 Intro, disclaimer, guest bio
• 02:35 Vulvovaginitis
• 05:35 Cellulitis and Bites
• 09:45 SPEP it Up
• 15:15 Outro

Tales from the Curbside Top Pearls

Click the links below for full show notes.

Vulvovaginitis

1. The vagina is a self-cleaning organ. Avoid soaps, fragrances and douches.
2. Genitourinary syndrome of menopause (GSM) is very common. Screen for it and offer treatment (daily moisturizers, as needed lubricants; topical estrogen).
3. Treat recurrent Bacterial Vaginosis with 16 weeks metronidazole gel and recurrent candida vulvovaginitis with weekly fluconazole for 16 weeks or daily boric acid suppositories for two weeks.

Cellulitis + Bites

1. Compression therapy can prevent recurrent lower extremity cellulitis
2. Clenched fist injuries qualify as human bites and should be treated aggressively with antibiotics +/- imaging and consultation
3. Schedule a follow up to assess cellulitis and bites. Write antibiotic prescriptions over a range (e.g. 5-7 days or 7-10 days) and flex shorter or longer as needed.

Top Pearls MGUS + SPEP

1. The SPEP detects the presence of an M-spike (monoclonal process) while Immunofixation denotes the type immunoglobulin and/or light or heavy chain present.
2. Illness scripts: Multiple myeloma = hyperCalcemia, renal disease, anemia and bone lesions. Amyloidosis = nephrotic syndrome, cardiomyopathy, neuropathy (may be sensory and motor. Waldenstrom’s = anemia, neuropathy (distal, symmetric polyneuropathy) and hyperviscosity

Hyperviscosity syndrome = Nosebleeds, headaches and blurry vision

Links

1. #247 SPEP It Up with Dr Jorge Castillo (produced by Nora Taranto)
2. #246 Take a Bite out of Cellulitis with Dr Boghuma Titanji (produced by Matt Watto, graphic by Beth Garbitelli)
3. #244 Vulvovaginitis for All Ages with Dr. Monica Christmas (produced by Kate Grant and Sarah Phoebe Roberts)

Goal

Listeners will review tops pearls from recent curbsiders episodes

Learning objectives

After listening to this episode listeners will…

1. Recall the top 3 causes of vulvovaginitis and the basics of diagnosis and management
2. Review key concepts of treating cellulitis and bites
3. Discuss the diagnostic tests pertinent to MGUS and illness scripts for recognizing myeloma, amyloidosis and Waldentrom’s macroglobulinemia

Disclosures

The Curbsiders report no relevant financial disclosures. 

Citation

Watto MF, Williams PN, Brigham SK. “#249 Tales from the Curbside: Vulvovaginitis, Cellulitis, Bites, MGUS, SPEP”. The Curbsiders Internal Medicine Podcast. http://thecurbsiders.com/episode-list Final publishing date January 4, 2021.