My Heart will go on...
This is the current guideline for anti-platelet therapy in patient's who receive a drug eluting stent.
Low dose CT Scan without contrast
In a young patient with suspected acute appendicitis, this is the initial preferred imaging test of choice for diagnosis.
Ultrasonography
This is the preferred imaging test in evaluation of suspected kidney stones
CT Abdomen/pelvis without contrast
Men often take this supplement to alleviate symptoms of benign prostate hyperplasia
Saw Palmetto
In addition to ACE-inhibitors, beta blockers, hydralazine +nitrates (AA population), and ICD placement, this medication has a mortality benefit in patients with congestive heart failure with reduced ejection fraction.
Spironolactone
A 40 year old male presents to your clinic with productive cough, fever, and shortness of breath. His vital signs show temperature of 101, but are otherwise stable. A chest x-ray confirms a right sided pneumonia. This medication is the most appropriate first line treatment in this scenario.
Macrolide/doxycycline
A 66 y/o F with h/o HTN, angina and carotid endarterectomy presents with acute upper abdominal pain. There is epigastric tenderness, but no guarding/rigidity or other signs to explain the level of pain experienced. Initial labs are normal. You order a CT angiogram to confirm this suspected diagnosis.
Acute mesenteric ischemia
RBC casts in the urine sediment are pathognomonic for this condition.
Acute glomerulonephritis
This supplement is often taken to assist with cognitive function. However, it is contraindicated in patients on aspirin or anticoagulation therapy due to risk of intracerebral hemorrhage.
Ginkgo Biloba
A 32 year old female presents for routine physical examination. She complains of exertional dyspnea. A systolic murmur is auscultated, and echocardiogram reveals hypertrophic cardiomyopathy. Initial treatment should be started with this class of medications.
Beta blockers.
- HCM is often asymptomatic, though can lead to SCD. Murmurs increase with valsava maneuver. Initial tx is beta blockers, or non-dihydropyridine CCB.
Asthma is classified into this category if a patient reports daily symptoms, nighttime awakenings >1 time per week, and has an FEV1 between 60-80%
Moderate persistent asthma
In patient's with advanced cirrhosis, unresponsive to medical management, this procedure can be attempted to decrease portal hypertension.
BONUS: What condition associated with cirrhosis does this procedure worsen?
TIPS
Hyperammonemia
These are the current indications for emergent hemodialysis
Acidosis (pH <7.2), electrolyte disturbance (hyperkalemia with EKG changes), intoxications, overload, and uremia (AMS, pericarditis, bleeding, seizures)
This supplement is often taken to alleviate symptoms of menopause.
Black Cohosh
5 days
- CHADSVASC <6 is considered low risk. Resume warfarin 12-24 hours post-op. If high risk, will need bridging therapy with LMWH.
THis condition should be suspected in this scenario:
A 42 year old female presents with progressive SOB, limiting her ADL's. There is no cough or chest pain. She is a 1 ppd smoker x 20 years. She has a BMI of 42.4. She has 1+ BLLE edema. CXR is normal. Spirometry reveals a decreased FVC with normal FEV1/FVC ratio. BMP shows a bicarb level of 35.
Obesity Hypoventilation Syndrome
This is the current indication for endoscopy in patient's with dyspepsia.
Age >55, or age <55 with negative H. pylori, no NSAID/ETOH use, and failed PPI trial
Microscopic hematuria is defined as this many red blood cells per HPF on UA
3
- if positive, repeat UA and r/o benign causes. If persistent, need to obtain imaging studies, cytology and possible cystoscopy.
This supplement is often consumed in treatment of anxiety disorders. Its most significant side effect is hepatotoxicity.
Kava Kava
A 64 y/o male presented with chest pain. Despite oxygen and pain relief, he loses consciousness, and becomes pulseless and apneic. CPR is started immediately. Cardiac monitoring shows ventricular tachycardia with HR of 170. This intervention is the most appropriate next step.
Defibrillation
A 55 y/o M with a history of metastatic colon CA and prior hemorrhagic stroke presents to the ER with significant SOB and CP. On examination, he is persistently hypotensive and tachycardic. CXR is negative. CT chest however confirms a massive pulmonary embolism. This is the most appropriate next step.
Surgical embolectomy/catheter directed lysis
This vascular malformation is associated with aortic stenosis, in a condition known as Heyde's syndrome
Angiodysplasia
This type of nephrotic syndrome presents with a spike and dome appearance on electron microscopy, and is often associated with malignancy or autoimmune diseases
Membranous nephropathy
This supplement is often consumed for symptoms of depression, anxiety and sleep disorders. However, it is a potent CYP inducer and has multiple drug-drug interactions.
St. John's Wort