What is the single greatest cause of preventable death?
Tobacco use (no shit)
What are the "5 A's" of tobacco cessation?
Ask about use
Advise to quit
What are the 2 non-nicotine pharmacological treatment adjuncts for smoking?
Buproprion (wellbutrin) and varenicline (chantix)
A pregnant woman wants to quit smoking, what can we prescribe her?
Both Buproprion (wellbutrin) and varenicline (chantix) are category C and considered safe in pregnancy. nicotine replacements are category D.
Buproprion = antidepressant (helps with withdrawal symptoms and cravings)
Varenicline = nicotonic receptor partial agonist (decreases cravings and pleasurable effects)
True or False: Most smokers fail quitting multiple times before finally quitting.
A 65yo female presents with worsening dyspnea, fatigue, dizziness, and palpitations. She has conjuctival pallor on PE. Most likely diagnosis?
A 65yo female presents with worsening dyspnea, fatigue, dizziness, and palpitations. She has conjuctival pallor on PE. Next Step?
CBC with RBC indices, and a reticulocyte count
A 65yo female presents with worsening dyspnea, fatigue, dizziness, and palpitations. She is demented and confused. On PE she has Glossitis, decreased vibratory senses, ataxia, paresthsia, and pearly gray hair at her temples. What is the most likely cause of her anemia?
Vitamin B12 deficiency. If she did not have the neurological defects it is suggestive of a folate deficiency
A 65yo female presents with worsening dyspnea, fatigue, dizziness, and palpitations. On PE she has Glossitis, koilonychias (spoon nails), and dysphagia. What is the most likely cause of her anemia?
Profound iron deficiency.
Causes of microcytic anemia?
Iron deficiency (most common), chronic disease, thalassemia, sideroblastic
Causes of macrocytic anemia?
B12 deficiency (most common), folate deficiency (most common) (yes they are both most common. deal with it), hypothyroid, Chemo, Liver disease, myelodysplastic syndrome
B12 and Folate are both needed to generate precursors for DNA and RNA division. Without them, RBCs grow (in preparation for chromosomal duplication) and stall because they cannot pair precursors to multiply..."stuck being big" = megaloblatic anemia
Causes of normocytic anemia?
renal failure, multiple myeloma, acute blood loss, hemolysis
How do you differentiate anemia due to low iron from chronic disease?
Low Iron: Low serum Iron, Low Transferrin, Low ferritin, High TIBC
Chronic Disease: Low/Normal serum iron, Low/normal transferrin, high/normal ferritin, Low TIBC
Ferritin = storage form
Transferrin = carrier form (blood)
TIBC = blood test for iron (transferrin should normally be 1/3 saturated)
What is the hemoglobin threshold for transfusion?
Less than 7
What is the most common cause of B12 deficiency?
Pernicious anemia (lack of intrinsic factor)
What is the most common cause of folate deficiency?
What is a common cause of anemia in geriatric patients?
A 40 yo male comes in complaining of nausea, vomiting, and diarrhea. on PE he has dry mucus membranes (or is found to have orthostatic hypotension). what is the appropriate next step?
fluid resuscitation. either NS or LR
what % of acute diarrhea is infections.
"Doc! I just got back from Mexico and i cant stop shitting. what's causing this?"
most likely enterotoxigenic E Coli
"Doc! I just got back from camping and i cant stop shitting. what's causing this?"
most likely Giardia
"Doc! I just got back from the on base family day cook-out and i cant stop shitting. what's causing this?"
6 hours ago? Staph Aureus
8-12 hours ago? Clostridium perfringens
12-14 hours ago? E coli
"Doc! I cant stop shitting. I think I ate some undercooked chicken." what's causing this?
most likely Salmonella or Shigella
"Doc! I cant stop shitting. I think I ate some undercooked hamburger." what's causing this?
enterohemorrhagic E. Coli
"Doc! I cant stop shitting. I think I ate some raw seafood." what's causing this?
Vibrio, Salmonella, or hepatitis A
Which patient groups with acute diarrhea require a workup? (hint most dont)
if they have a fever, bloody stools, or dehydration. Also kids, geriatrics, and immunocompromised patients.
What antibiotic is classically (as in on tests) associated with C. Diff?
What is the best way to prevent the spread of diarrhea?
wash your nasty ass hands
"Hey doc im going to mexico this weekend, and I dont want to get diarrhea. What can I do?"
Avoid raw fruits and veggies, dont get ice or use tap water, Use bottled water to brush your teeth.
a patient has had acute diarrhea for >3 days and your sure that its bacterial. what antibiotics should you use?
Ciprofloxacin 500mg BID for 3 days (not to be used in pregnant women or children)
Azithromycin for pregnant women (single 1000mg dose) or children (10mg/kg daily x 3 days)