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Jimmy Stewart, MD Professor of Medicine and Pediatrics Division of General Internal Medicine and Hypertension Program Director, Med/Peds Program University.

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Presentation on theme: "Jimmy Stewart, MD Professor of Medicine and Pediatrics Division of General Internal Medicine and Hypertension Program Director, Med/Peds Program University."— Presentation transcript:

1 Jimmy Stewart, MD Professor of Medicine and Pediatrics Division of General Internal Medicine and Hypertension Program Director, Med/Peds Program University of Mississippi Medical Center

2 Screening Vaccinations Prophylaxis Education

3 All adult ages yo 40+ or 10 years prior to relative FOBT, flex sig for “average risk” Colonoscopy - every 5-10 years for high risk

4 PSA - NOT recommended for routine screening Greatest sens in AA or high risk group

5 High Risk (CAD or equivalent) – statin LDL > 190 mg/dL – statin ASCVD risk > 7.5 % - statin

6 MMR* Oral Polio Nasal influenza Yellow fever Smallpox Typhoid BCG Varicella (including Zostavax)

7 HBV Influenza Pneumococcal Hib MMR/Td

8  Asplenia  >65 yo every 5 years  Chronic disease (including DM)

9 Yearly >50 yo Healthcare workers Childcare workers Household contacts of above

10 >55 yo? History of zoster not important

11 Meningococcal - not against “B”, college freshmen Cholera - DOESN’T WORK

12  Flouroquinolones  Azithromycin  Must take daily

13 Mild: 1-2 stools/day - loperamide Mod: 3 stools/day - single dose Abx Sev: 6 stoos/day - Abx x 3 days with loperamide

14  Flouroquinolones  Azithromycin

15  Chloroquine-resistant - Mefloquin (neuro SE’s)  Chloroquine  Others - doxy, primaquine, azithromycin

16 Gray - resistant; Blue - sensitive

17  Rifampin  Cipro  Rocephin - pregnancy

18  Smoking cessation  Firearm safety  Bladder Cancer  Folate supplementation  Osteoporosis  CVA

19  Isopropyl (rubbing alcohol)  Methanol (wood alcohol)  Ethylene Glycol  Salicylates  Acetaminophen  Theophylline Lithium Tricyclics PCP Anticholinergics Cholinergics CO Cyanide Pb Insecticides

20  CNS depression  Osmolal gap  Early lavage  Hemo/peritoneal dialysis

21  Visual changes  AG met acidosis  Treat with ETOH, folate, dialysis, fomepizole

22  Ca oxalate crystals  AG met acidosis  Treat with ETOH, bicarb, calcium, dialysis, fomepizole

23 Calcium Oxalate: “folded box”

24  AG met acidosis  Classic presentation: AG with pH 7.4 and history  Treatment - lavage, alkalinization, hemodialysis, charcoal

25  N - acetylcysteine  Early gastric emptying  Normogram

26  Seizures  Treat with diazepam, lavage, charcoal, cathartic

27  MS changes, Parkinsonian  DO NOT GIVE CHARCOAL  Lavage, electrolytes/fluids, hemodialysis

28  Tachycardia, long QT, PR, QRS  Hemodialysis INEFFECTIVE  Alkalize  Lidocaine/phenytoin

29  Agitation, seizures, dystonia, HTN  Give ammonium Cl to acidify the urine  Diazoxide for HTN

30  “Red as a beet, dry as a bone, blind as a bat, mad as a hatter, and hot as a hare”  Supportive care  Physostigmine

31  Scopolamine  Antihistamines  Antipsychotics  Antispasmotics  Cyclic antidepressants  Mydriatics

32  “SLUDGE”  “DUMBELS”  Skin cleansing  Atropine  2-PAM for organophosphates

33  CNS depression  mild-mod: 15-30%  mod-sev: >30%  Fatal: >50%  O2

34  Almond breath, bright red venous blood  Amyl nitrate  3% Na nitrite  Sodium thiosulfate

35  Autonomy  Beneficence  Nonmaleficence  Cultural differences  Confidentiality  Brain death - NO EEG REQUIRED!

36  Clinical Risk  Functional Capacity  Risk of Surgery

37  History  PE  ECG (men >40 yo, women >55 yo, CAD)

38

39  Excellent: >7 METs  Moderate: 4-7 METs (angina walking >2 blocks)  Poor <4 METs (angina walking 1-2 blocks)

40  Low - endoscopy, local biopsy, breast biopsy, vasectomy, cataract  Mod - CEA, intraperitoneal, intrathoracic, orthopedic, prostate, head and neck  High - emergencies, long procedures/fluid shifts, CVS (cross- clamping aorta or bypass

41  Moderate risk with poor functional capacity  Moderate risk with good functional capacity and high risk surgery  High Risk - all

42  Exercise stress treadmill  Dipyridamole thallium  Dobutamine stress echo

43  Low risk patient goes directly to surgery without testing  Moderate risk patient with good functional capacity goes directly to nonvascular surgery  High risk patient need further workup

44  Glaucoma  Retinal Detachment  Retinal Vascular Occlusion  Optic Neuritis  Vitreous Hemorrhage  Alkali/Trauma Iridocyclitis Keratoconjunctivitis Viral conjunctivitis Bacterial conjunctivitis Neisseria conjunctivitis Endophthalmitis

45  Asian American with severe acute nausea, headache while in movie theater  Ocular emergency  Pupillary constriction

46  Acute trauma to head/globe  Flashes/streaks of light, showers of black dots  Ocular emergency

47

48  Sudden, PAINLESS BLINDNESS  Mostly embolic  Ocular emergency

49  Ocular pain with eye movement, loss of vision  MS

50  Sudden painless loss of vision  Must look for retinal detachment

51

52  VA  Anterior chamber: hyphema, corneal laceration, subconjunctival hemorrhage, pupil distortion  Irrigation for alkali  Referral

53

54

55  VA decreased  Pain  Photophobia  Pre-auricular adenopathy  Discharge

56  Ocular pain, photophobia, ciliary flush  Emergent referral  Behcet’s  AK  IBD  JRA  Reiter’s Syndrome Sarcoid Syphillis TB Lyme disease

57

58  Elderly, middle-age women  Graves disease  RA  Sarcoid

59  Most common cause of red eye  Pre-auricular LAD

60

61  Staph, strep, H. flu, Pseudomonas, Moraxella  Antibiotic treatment: Polytrim, gent, tobra, fluoroquinolones

62

63  Hyperacute course  MUST TREAT WITH SYSTEMIC ABX!  3rd generation Cephalosporin IM/IV

64  Eye pain with movement  Chemosis  Hypopyon  Fever  Eye discharge

65  Alkali  Trauma  Orbital Cellulitis  Central retinal artery occlusion  Acute angle closure glaucoma  Optic nerve infarction in giant cell arteritis

66  Penetrating injury  Endophthalmitis  Retinal detachment  Keratitis/keratoconjunctivitis

67  Cental Retinal vein occlusion  Optic neuritis  Vitreous detachment/hemorrhage


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