To Do

Thrombocytopenia

1) How would you build a DDx for Thrombocytopenia?
2) When should BM biopsy be done?
3) What are the 5 causes of increased platelet consumption / destruction? What are the three DDx that requires urgent eval? HIT TTP DIC 
4) Pathophysiology of TTP, HIT, DIC - common to all these three? 
5) Pathophysiology of ITP?  


MCW
I) Clinical Practice
1) Pathophysiology 
alcohol metabolism, 
2) Physical Examination 
3) Disease Specific 
Ischemic colitis vs mesenteric ischemia; Leucocoria; Strep gonnadi; Krukunburg tumor; Nausea; Penetrating Ulcer in CD; 
4) Pharmacology 
Risperidone; Seroquel; Steroids; 

II) Research 
1) Medical Student Research
2) Resident Research 


IM-ACT : Co - CHAIR 

Tenure application MERCER



Pneumonia: Urinary Test
COPD: Not recognizing and starting treatment
Magnesium replacement and recheck
Syncope: No orthostatics BP
Anemia of Bleeding: Stopping Plavix, Ongoing IV fluid
Abdominal Pain: No pelvic exam

EPIC inbasket

  • Heme: Anemia, CLL, AML, Hypereiosinophilic syndrome, 


Rheum:
  • MKSAP Gout: Q 48 BPP, Q59 Duraiton of Colchicine, 93 CPPD diseases causing osteoarthritis  


Cards
  • Why does S4 sound occur
    • resulting from a forceful left atrial contraction and movement of blood into hypertrophied LV
  • Screen for secondary HTN
    • < 25  yr 
    • Resistant HTN
  • Low risk factor finding in Stress test
    • Medical management prior to Cath: ASA, Statin, and either BB or CCB and or long acting nitrate 
  • Use of DAPT in a Cardiac patients 

  • Antiplatelet on patient underoing non-cardiac surgery 
2016 ACC/AHA Guideline Focused Update Circulation 2016

  • HFrEF: NYHA 2 or more. If Cr < 2.5  in men and < 2.0 in women, and K < 5, start EPLERENONE 

Diagnosis and treatment of deep-vein thrombosis CMAJ 2006


  • Doxazosin is preferred not to be used in HTN as it makes HF worse as seen in ALLHAT Trial 
  • Pericardial Rub has 3 components 
    • Atrial Systole
    • Ventricular Systole
    • Rapid Ventricular fielding during early diastole 

Endo Topics to Read

Adrenal: 
1. Identify the causes of Adrenal Insufficiency related to normal aldosterone production?
2. What are the 8 symptoms, 5 signs, and 7 biochemical findings in adrenal insufficiency and their prevalence?
3. Identify the differences in the management of acute adrenal insufficiency vs chronic adrenal insufficiency?
4. What is adrenal escape mechanism?
5. What are the screening and confirmatory tests for conn's syndrome?
6. What are the precautions one should take in interpreting PRA tests results?
7. What are the 6 tests for Pheo, and what is the sensitivity and specificity of each tests and how to decide Possible, likely, unlikely pheo based on lab values?
8. Name drugs that interfere with Pheo assays and in what ways?
9. What is the typical radiological findings of Pheo?
10. Name 3 Pheo syndromes?
  1. Student and resident eval
  2. Complete EPIC deficiencies
  3. Green Card (follow up)
  4. Financial Planning 
  5. Research
Noon Conference Lecture Topics
  • Borderline Personality Disorder: Case example from EPIC
  • Insomnia: Case example from Epic
  • Cryptogenic Stroke
  • Any Stroke
  • CAD and CABG
  • HTN and Hyperlipemia
  • any Sepsis 
  • EBM 2 lecture series
  • Allergic Rhinitis 
  • Asthma 
  • postmenopausal symptoms 

HIV Study : To IRB



MKSAP and Boards Score, and ITE Performance: Nick

ME Prevention Study:Inhospital
H and P:

A and P:
Diagnostic Error: Outpatient including obesity
EBM study 
Patient focused paper, vs any good paper of the week 

Metformin toxicity
HCAP 
CAP 
HUS 
MM 
Amyloidiosis 
Cryoglobunemia
Gangrene dry..

Psuedomonas ostemyelitis, and Temporal arteritis..shirlye williams..Purple Team 
Non-Germinal Cell DLBCL -- Mosley..Yellow team 
SLE Class III nephritis with GBS - Simmons - Blue 
Alb : Low; NO Urine Albumin is done  

Increased Globulin. Normal SPEP, S IFA increased IgG, Normal FLC 
ALP increase.
CRP, ESR increased. 
Decreased Testesterone, but normal hcg
RPR reactive, FTA-ABS reactive.
Resistant HTN 
Transverse Myelitis 
Rapidly progressive Dementia vs Pseudodementia vs Vasculitis (elevated CRP and ESR)
Salmonella Bacteremia (species unknown)
Multiple Sclerosis
Tachycardia
Intractable N and V 
Fungal Calcification 

Mechanism of Polyuria with Hyperkalemia
MM - IL1 mediated osteoclast activation
Lymphoma - causes direct activation of 1,25 hydroxylase (unlike due to macrophages in granulomatous disease)
Where is 1-alpha hydroxylase located in Kidney that PTH acts on? 

NAFLD vs Hep C..how to differentiate ?
PFT - bronchodilatation..Albuterol or anti-cholinergic combination?
Insomina - Ambien vs Restoril ?  
Erythrocytosis 
Ekg
Leg Cramps 

Question to ask to any heme-onc physician?

What to order when doing Flow Cytometry?
1) in a patient with leukocytosis? 
  • Concern for CLL, 
  • Concern for AML, or ALL
2) in  a patient with M-spike present in SPEP, or FLC?

Nucturnal Leg Cramps 
Autism / Autistic Spectrum of disorder. 
Silver Nitrate : Use 
Mammogram 
Red Eye 
Neuro eval
Renal stone update page 

Done:
Sleep Apnea 

Live Vaccines
Adeno virus (military only)
Rota virus
Yellow
Typhoid
MMR
MMRV (varicella)
Varicella
Herpes Zoster 

Disease to be monitored in a patient with RA on treatment 
CHF
Skin cancer (non-melanoma)
Melanoma
Lymphoproliferative Disease
Hep B and Hep C 

Red Team 
Thrombocytopenia / pancytopenia in a patient with Low Fibronogen, and High INR ??? 
High INR?? in cirrohosis 
Use of MELD??
Use of DF ?? Benefit of prednisone ?? 

Asymptomatic Carotid Stenosis. 
  1. Cards
    1. CHF
    2. Atrial Fibrillation
    3. Chest Pain / ACS 
    4. Arrythmias 
    5. EKG
    6. Elevated troponin 
    7. HTN
      1. Resistant or Difficult to control HTN 
    8. HLD
    9. Syncope 
  2. Pulmonary 
    1. Asthma
    2. COPD exacerbation 
    3. Management of Chronic Refractory Cough
    4. Pleural Effusion 
    5. Sarcoidosis 
  3. Neuro
    1. Stroke / TIA 
    2. CN Lesion: 3,4,6; CN 7; 
    3. Ataxia / Dizziness / Vertigo 
    4. Headache
    5. Seizure
      1. New onset
      2. Partial Seizure
      3. Seizure medications 
    6. Delirium
    7. Wernikies Encephalopathy 
    8. dermatome / myotome - cervical radiculopathy 
    9. ALS 
    10. GBS - Simmons - Blue 
  4. Endo 
    1. DM 
    2. DKA / HHS / Hypoglycemia 
    3. Hyperthyroidism / Thyroid toxicosis 
    4. Thyriod Nodule 
    5. Adrenal Insufficiency
    6. Cushings Syndrome 
  5. GIM
    1. Pain Medication 
  6. GI
    1. N /V 
    2. Diarrhea /Constipation
    3. GI bleeding
    4. Pancreatitis
    5. Cholelithiasis / Cholecysitis / cholangitis 
    6. IBS 
    7. Acute Hepatitis 
    8. Cirrhosis
      1. DVT prophylaxis
      2. Ascitis
      3. SBP
      4. Hepatorenal Syndrome
  7. Heme
    1. Anemia
    2. Mechanism of IDA and ACD 
    3. Thrombocytopenia
    4. VTE (Need to add references) 
    5. DIC / HIT 
    6. Hypereosniphilic Syndrome 
  8. ID
    1. Sepsis
    2. DM with foot infection
    3. Cellulitis 
    4. Staph aureus Bacteremia
    5. Staph Epidermidis bacteremia
    6. Streptococcos mitis bacteremia
    7. Gram negative bacteremia 
    8. HIV
      1. Pathogenesis
      2. Diagnosis 
      3. Tests for New HIV patients 
      4. Treatment Strategy
      5. Systemic Manifestation of HIV  
    9. Non-HIV Viral Infection
      1. Hep B
      2. Hep C
      3. Herpes Zoster
    10. Meningitis 
    11. UTI 
    12. PNA and antibiotics 
  9. Nephro
    1. AKI
    2. CKD / ESRD 
    3. Sodium Disorders 
    4. Potassium Homeostasis (Hypokalemia and Hyperkalemia)
    5. Acid Base Disorder 
    6. IV Fluid and Fluid Replacement
    7. Rhabdomyolysis 
  10. Protein Calorie Malnutrition 
  11. Derm
    1. Bullous Skin Lesion 
  12. ACLS 
  13. Rheum
    1. SLE 
    2. Shoulder Joint and Subarcomial Bursa Injection
    3. Knee Joint Injection 
    4. OA 
    5. Back Pain 
  1. Nystagmus

2015 Recommendation for readmission  for HF 
Albert NM et al. CIrc Heart Fail. 2015.8 384-409
More the number of intervention, lesser is the readmission 






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