shuekomed-blog

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Humoral Hypercalcemia of Malignancy (HHM)

Associated with squamous cell carcinoma of the lung

HHM is a paraneoplastic syndrome that causes hypercalcemia due to the release of PTHrP by malignant cells.  It acts on PTH -1 receptors and causes increased bone resorption and reabsorption of calcium in the distal renal tubule.

#HHM #humoral hypercalcemia of malignancy #paraneoplastic syndrome #squamous cell carcinoma of the lung #lung cancer #endocrine #pulm #respiratory #hemeonc #hypercalcemia #PTHrP #hyperparathyroidism

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Kussmaul breathing

deep, rapid breathing associated with hyperventilation. This is usually associated with metabolic acidosis in DKA.

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Pulsus paradoxus

exaggerated decrease (>10mmHg) in SBP with inspiration. Associated with pericardial disease (eg cardiac tamponade) and can also occur in severe asthma and COPD

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Pulsus parvus et tardus

Pulses tardus = delayed or slow-rising pulse

Pulsus parvus = diminished or weak pulse

Usually used to evaluate carotid pulsation. It’s associated with severe aortic stenosis

#pulsus #parvus #tardus #aortic stenosis #carotid #cardiology #valve defects

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Bactrim for Solid Organ Transplant Patients

Patients who have solid organ transplants are immunesuppressed and are at higher risk for opportunistic infection, especially Pneumocystis pneumonia and CMV. The most effective prophylaxis? Oral trimethoprim-sulfa aka Bactrim

#bactrim #tmp smx #pcp #pneumocystis pneumonia #transplant #opportunistic infections #hemeonc

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Desensitization vs Alternative Therapy for Primary Syphilis

First off, what are the treatment for syphilis?

Penicillin G is first line for all stages!

Doxycycline is 2nd line for primary, secondary, and latent syphilis.

Ceftriaxone is 2nd line for tertiary syphilis 

So... when do you desensitize?  It’s an expensive and time consuming process so desensitization should only be used if the alternative treatment for syphilis is contraindicated.

For example

Pregnant women can’t receive doxy > desensitize

#syphilis #desensitization #infectious disease #management #treponema pallidum #doxycycline #ceftriaxone #pharmacology #treatment

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Exercise-associated Hyponatremia

Get this, ADH release can be triggered by nonosmotic stimuli (like exertion, pain, hypoglycemia, and nausea). So during intense exercise, ADH secretion is triggered. (like your body is preparing to save the water you’re about to lose to perspiration)

However, ingesting large amounts of hypotonic fluid (like water) before or immediately after a prolonged exercise COMBINED with ADH release due to nonosmotic stimuli can cause EAH.

Depending on the degree of hyponatremia, patients may be asymptomatic, mildly symptomatic (lethargy, nausea) or severely symptomatic (seizures, altered mentation)

#exercise induced #hyponatremia #SIADH #nephrology #hypotonic

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TB and Adrenal Insufficiency

TB can invade mulitple organs including spleen, liver, kidney, bone (remember Pott’s disease - TB in the vertebra?) and adrenal gland.  TB is the most common cause of chronic primary adrenal insufficiency in endemic areas.

What is the downstream effect of adrenal insufficiency in acid-base balance?

Adrenal insufficiency means no mineralocorticoids (ie no aldosterone) leading to salt wasting and decreased potassium and hydrogen excretion, leading to hyponatremia and hyperkalemia and metabolic acidosis.

#TB #adrenal insufficiency #ID #Infectious disease #endocrine #associations #adrenals #aldosterone #hyponatremia #hypernatremia #metabolic acidosis #normal gap

[shuekomed-blog]

Cholesterol Guidlines

Groups that may benefit from statin therapy

- individuals with clinical atherosclerotic cardivascular disease (ASCVD) - patients with primary LDL-C elevations >190 mg/dL - patients 40-75 years old with DM, LDL 70-189mg/dL - patients 40-75 years old without clinical ASCVD or diabetes, LDL 70-189 mg/dL and estimated 10-year ASCVD risk >7.5%

I recommend going through the ACC/AHA cholesterol guidelines

#cholesterol guidelines #outpatient #diabetes #statin therapy

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Enuresis Therapy

Bed alarms have the best evidence for long term success in managing enuresis therapy. 

Desmopressin, imipramine, and oxybutynin can be used if bed alarms are unsuccessful.

#enuresis #bed wetting #bed alarms #therapy #management #pediatrics #peds #pharmacology #desmopressin #imiparmine #oxybutynin

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Prevention of Preeclampsia

Aspirin at dosages 60-80 mg daily can decrease risk of developing preeclampsia, especially in high risk women.  Calcium can prevent preeclampsia in women with low calcium intake.

#preeclampsia #prophylaxis #prevention #pregnancy #obgyn #aspirin #calcium #risk

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Best initial test for work-up of male hypogonadism?

Morning total serum testosterone.

Repeat study if testosterone is indeed low.

#diagnostic test #lab #hypogonadism #male repro #testosterone #work up

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Mortality and Antioxidants

Another surprising finding, 78 randomized clinical trials show an increase in all-cause mortality associated with Vitamin E, A, and beta-carotene supplements. Vitamin C and selenium did not show any benefit or reduction in all-cause mortality.

So... are antioxidants really as good as they say?

Bjelakovic G, Nikolova D, Gluud C: Antioxidant supplements to prevent mortality. JAMA 2013;310(11):1178-1179.

#antioxidants #mortality #vitamins #supplementation #nutrtion

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Meniscectomy vs Sham Surgery

Apparently, meniscectomy shows no benefit over sham surgery in the treatment of torn meniscus. The best way to manage torn meniscus is through physical therapy.

#torn meniscus #knee #sham surgery #mensicectomy #family medicine #msk

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SSRI for Diarrhea-type Irritable Bowel Syndrome

Patients with diarrhea-type IBS may benefit from SSRI and TCA (like amitryptiline).  Remember that IBS seems to have a psychological component and is affected by stress. Based on this logic, it makes sense that SSRI would help improve symptoms.

#IBS #diarrhea #SSRI #TCA #management #treatment #pharmacology #irritable bowel syndrome

[shuekomed-blog]

Renal Equations

Anion Gap

[Na] - ([Bicarb] + [Cl])

[Na] - [Bicarb] - [Cl]

Osmolal gap should be calculated in a patient with anion gap metabolic acidosis and suspected ingestion.

Osmolal gap = Measured serum osmolality - Calculated serum osmolality

Calculated serum osmolality

calculated serum osmolality = (2*Na) + (glucose/18) + (BUN/2,8)

#renal #equations #nephrology #anion gap #osmolal gap #calculated serum osmolality

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LFTs in Alcoholic Hepatitis

Alcoholic hepatitis usually has modest increase in AST and ALT.  Levels are usually <300 IU/L and almost always <500 IU/L. Alcoholic hepatitis usually has an AST:ALT ratio of greater than 2. GGT and ferritin (acute phase reactant) would most likely be elevated.

#LFT #alcoholic hepatitis #AST #ALT #ferritin