Tips for IM Attendings – Chapter 13 – Understanding Laboratory Tests
We order many laboratory tests. Learners report laboratory tests regularly, but too often they lack a sophisticated understanding of their meaning.
Regularly a new student or intern reports that the labs are “unremarkable” (an unfortunate term). As a lover of lab test interpretation I cringe, especially when I look at the labs for clues. Excellent internists know that laboratory tests provide clues and those clues sometimes lead to answers.
The best attending physicians will study and learn how to interpret all the common tests and many of the less commonly ordered tests. Here is the good news, most learners ap...
Source: DB's Medical Rants - July 24, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
DM / DNB Cardiology Entrance New Test Series 1
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Source: Cardiophile MD - June 28, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
Bivalirudin – Cardiology MCQ
Recommended test for monitoring the effect of bivalirudin during cardiopulmonary bypass:
a) Activated clotting time (ACT)
b) Ecarin clotting time (ECT)
c) Prothrombin time (PT)
d) Activated partial thromboplastin time (aPTT)
Correct answer: b) Ecarin clotting time
Reference:
Salter BS et al. Heparin-Induced Thrombocytopenia – A Comprehensive Clinical Review. J Am Coll Cardiol. 2016;67(21):2519-2532. (Source: Cardiophile MD)
Source: Cardiophile MD - May 27, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Heparin induced thrombocytopenia – Cardiology MCQ
Alternative anticoagulation for a patient with HIT (Heparin induced thrombocytopenia) should not include:
a) Low molecular weight heparin
b) Warfarin
c) Argatroban
d) a and b
Correct answer: d) a and b
Both LMWH (low molecular weight heparin) and warfarin can worsen the thrombin generation and risk for thrombosis. LWMH can cross react with HIT antibodies in up to 90%.
Argatroban is a direct thrombin inhibitor which has been approved by U.S. Food and Drug Administration for treatment of thrombosis in HIT [1].
Reference:
Salter BS et al. Heparin-Induced Thrombocytopenia – A Comprehensive Clinical Review. J Am Coll ...
Source: Cardiophile MD - May 27, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Research and Reviews in the Fastlane 134
This article is a large, population-based, retrospective cohort of adults > 65 years of age. It compares those who were prescribed a macrolide with those prescribed a non-macrolide antibiotic looking at the primary outcome of a presentation for a ventricular dysrhythmia at 30 days and a secondary outcome of all-cause mortality at 30 days. They found no difference. While it’s a suboptimal study methodology, this is further evidence that we need not fear these complications. But, this shouldn’t stop us from restricting treatment to only those who need it (i.e. don’t prescribe a Z-pack for a URI).
Recomme...
Source: Life in the Fast Lane - May 11, 2016 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Administration Clinical Research Education Emergency Medicine Intensive Care critical care R&R in the FASTLANE recommendations research and reviews Resuscitation Source Type: blogs
Fight Aging! Newsletter, April 11th 2016
In this study we expanded the study by investigating associations of the rest blood parameters with age, and associations between generations, aiming to seek candidate factors associated with familial longevity. Associations of blood parameters in centenarians (CEN) with their first generation of offspring (F1) and F1 spouses (F1SP) were analyzed.
In this study, using association and further comparison analyses we identified several blood parameters that may contribute to longevity. First, total cholesterol (TC) and triglyceride (TG) increased with age until 80 years, but decreased in centenarians, indicating that l...
Source: Fight Aging! - April 10, 2016 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Senescent Cell Clearance and a Focus on Delaying Skin Aging
Skin aging is a fixation in the broader community beyond the sciences, perhaps the more so because there is no effective treatment to slow or turn back skin aging. Life-long exercise and calorie restriction are the only thing that works. When looking at what you can go out and buy, all that does exist are a few marginal cosmetic approaches that don't address the actual underlying processes, and beyond that a very large number of people lying through their teeth about what their products are capable of achieving. An enormous amount of money changes hands on the basis of those lies, enough to sustain sizable industries. The ...
Source: Fight Aging! - April 7, 2016 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
To Improve Pandemic Preparedness, Update The Priority Review Voucher Program
Legislation recently introduced in the U.S. House of Representatives would add the Zika virus to the list of diseases in the Food and Drug Administration’s (FDA) priority review voucher (PRV) program. The Senate HELP Committee has also recently advanced similar legislation. This is a positive step that would help incentivize needed research and development (R&D) to fight the disease. However, it also illustrates the fact that the PRV platform could be used far more proactively to help address future pandemics before they strike.
Incentive For Innovation
In 2007 the US government created the PRV as an incentive to dri...
Source: Health Affairs Blog - March 22, 2016 Category: Health Management Authors: Kenneth Gustavsen Tags: Drugs and Medical Technology Featured Global Health Congress Ebola FDA outbreaks pandemic priority review Research Zika Source Type: blogs
Peritoneal Taps for Removing Ascites Fluids
Paracentesis, or a peritoneal tap, is a procedure emergency physicians often perform to obtain ascitic fluid for diagnostic or therapeutic purposes. Catheter aspiration of fluid is performed to determine the etiology in new onset ascites, to look for infection or presence of cancer, or simply to relieve pressure from a painful, distended abdomen that sometimes can interfere with breathing. Contraindications to the procedure might include an acute abdomen, severe thrombocytopenia, or a coagulopathy. Relative contraindications include pregnancy, a distended urinary bladder, abdominal wall cellulitis, adhesions, or distended ...
Source: M2E Too! Mellick's Multimedia EduBlog - March 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
You Decide: The Risks and Benefits of the MMR Vaccination
Most of us weigh the risks and benefits of medical procedures prior to obtaining them. We sign an informed consent form with an understanding of the potential harm versus the perceived benefits.
In the case of vaccinations, the great majority of parents obtain vaccinations for their children, influenced by the “sales pitch” and “scare tactics” used by physicians. We are assured that the vaccination is safe and will protect us and our children from the various targeted deadly diseases. If we blindly trust our doctors, as I once had, we readily agree.
It is important that we think critically before agreeing to any va...
Source: vactruth.com - February 18, 2016 Category: Allergy & Immunology Authors: Michelle Goldstein Tags: Logical Michelle Goldstein Top Stories autism Centers for Disease Control (CDC) MMR vaccine vaccine injury Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 9
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Source: Cardiophile MD - January 27, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 8
This study found that though it is often associated with coronary artery disease (CAD), it can also occur in those without significant CAD. It was not specifically associated with disease of right coronary artery disease.
This cardioinhibitory response may be a manifestation of the Bezold-Jarisch reflex. Bezold-Jarisch reflex inhibits sympathetic activity (sympathetic withdrawal) and increases parasympathetic activity, resulting in bradycardia, which may be associated with vasodilatation, nausea and hypotension. Bezold-Jarisch has been described in the setting of inferior wall infarction and coronary angiography. Origin...
Source: Cardiophile MD - January 26, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ Cardiology X-ray Featured Source Type: blogs
A Man with Thrombocytopenia via Now@NEJM
Posted on infosnack. (Source: Kidney Notes)
Source: Kidney Notes - January 15, 2016 Category: Urology & Nephrology Authors: Joshua Schwimmer Source Type: blogs
Funtabulously Frivolous Friday Five 125
Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia…introducing Funtabulously Frivolous Friday Five 125
Question 1
How often does acute angioedema occur as a complication of IV thrombolysis for acute stroke? In which patients is it most common? Which part of the body is typically affected?
+ Reveal the Funtabulous Answer
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Angioedema occurs in 1.3% – 5% of cases.
Patients taking ACE-inhibitors are predisposed.
It...
Source: Life in the Fast Lane - November 13, 2015 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five angioedema Bryant's sign Chvostek sign DRESS syndrome Kindling Stabler's sign Source Type: blogs
