Q 1: What risk factors and elements of E.P.’s presentation are consistent with a diagnosis of IC? Risk Factors: Smoking Diabetes Being overweight Sedentary lifestyle High cholesterol High blood pressure Older age (55 for men) Clinical Presentation Right upper thigh pain while walking The pain is relieved within minutes after he stops walking Ankle-to-brachial index (ABI) is 0.7 (normal: > 0.90).   Q 2: What are the therapeutic goals in treating E.P. and what interventions should be initiated to prevent claudication pain and arrest progression of his disease? Therapeutic goals: HbA1c goal <7.0 percent, fasting blood glucose <100 Total cholesterol <200, LDL …

Clinical Situations  M.M., a 63-year-old woman, has had Type 2 diabetes for 10 years. She is currently taking Metformin 500 mg PO TID & insulin glargine 47 units at bedtime. Her A1C is 8.2%. She tries to follow a meal plan that a dietitian developed for her but her BMI remains 31 kg/m2. Her physical activity is limited because of an arthritic knee, for which she plans to have knee replacement surgery in the future. Other medical problems include HTN, and dyslipidemia, which are both well controlled. Her medications are HCTZ 25 mg PO Daily, benazepril 40 mg PO Daily, and atorvastatin …

Treatment for Hyperemesis gravidarum Management of nausea without vomiting begin dietary changes and avoid trigger if nausea does not improve then add pyridoxine and if symptoms still persistent then add doxylamine pyridoxine However, if the vomiting does not resolve then discontinue doxylamine pyridoxine and begin either Dimenhydrinate, meclizine, and diphenhydramine if the vomiting resolves then continue diet changes, avoid triggers and continue medication one more week and then gradually discontinue Management of vomiting without hypovolemia First begin dietary changes and doxylamine pyridoxine and if the vomiting resolves then continue diet changes, avoid triggers and continue medication one more week and …

Endometrial cancer Incidence: Mc gynecologic malignancy in the US 4th most common CA of American women (breast, bowel, lung) MC curable GYN Cancer in US MC postmenopausal 50-60y peak 3rd MC cause of GYN CA deaths (behind ovarian & cervical) 25% pre 75% postmenopausal 61 median age Risk factors: Unopposed estrogen dependent neoplasm HRT w/o Progesterone Obesity – with ↑ adipose → ↑ peripheral Δ of androstenedione to estrone via aromatase Nulliparous – longer period of unopposed estrogen (b/c progesterone ↑ in pregnancy) Chronic anovulation or late menopause DM & HTN – b/c these pts often obese PCOS – ↑ …

Rhabdomyolysis- Clinical Presentation example: An 18-year-old marathon runner has been training during the summer. He is brought to the emergency room disoriented after collapsing on the track. His temperature is 102°F. A Foley catheter is placed and reveals reddish urine with 3+ blood on the dipstick and no cells are seen microscopically. Which of the following is the most likely explanation for his urine? Underlying renal disease Prerenal azotemia Myoglobinuria Glomerulonephritis Pathophysiology Rhabdomyolysis is a syndrome that is caused by injury to skeletal muscle fibers which cause the intracellular content to leak into the circulation. Most common intracellular contents that …

DKA-Diabetic ketoacidosis bloodwork Essentials lab finding: Hyperglycemia greater than 250 mg/dL (13.9 mmol/L). Metabolic acidosis with blood pH < 3; serum bicarbonate less than 15 mEq/L. Serum positive for ketones. Can be caused by: More common among type 1 diabetes patients during the course of infection, trauma, myocardial infarction, or surgery due to increased insulinrequirements Under severe stress type 2 diabetes patient can also develop DKA Symptoms and Signs polyuria and polydipsia marked fatigue, nausea, and vomiting Abdominal Pain &tenderness may occur Drowsiness Dehydration Physical examination rapid deep breathing “fruity” breath odor of acetone Hypotension with tachycardia indicates profound fluid and electrolyte …

Pathophysiology of Pulmonary Atrial Hypertension? Sigh and symptoms of PAH and as a medical provider when should we be  concern?  What is Pulmonary Atrial Hypertension? Pulmonary arterial hypertension (PAH) is a disease of small pulmonary Artery which is a rare disorder of the blood vessels in the lungs. The pulmonary arteries become narrowed and the pressure in the arteries rises above the normal limits. The normal PAH is <25 and when the pressure is >25 that’s when it is considered pulmonary arterial hypertension. This causes strain on the right side of the heart and may become life-threatening. PAH may be …

Discuss the appropriate next step for pharmacologic management of D.S’. dyslipidemia, along with pharmacologic agents for her comorbidities. Please briefly justify/explain your choice/s of pharmacologic agent/s (Please include the complete regimen). According to the American Heart Association, patients between the age of 40-75 with diabetes and an LDL-C level of ≥70 mg/dL should be on moderate-intensity statins without calculating 10-year ASCVD risk. Additionally, diabetes mellitus patient between the age of 50-75 are at higher risk, so the American Heart Association suggest using “high-intensity statin to reduce the LDL-C level by ≥50%”. Based on the American Heart Association recommendation, our patient, D.S., …

Session #1 D.S. is a 65-year-old white woman, who implemented lifestyle modifications for her dyslipidemia 6 months prior to her follow-up clinic visit last December. She has a Hx of gout, chronic nonischemic HF (LVEF 28%), and diabetes (diet controlled) as well as a 20 pack-year smoking history (quit 5 years ago). Her medications included lisinopril, furosemide, metoprolol succinate 25 mg Once Daily. Her vital signs included BP 124/80 mm Hg, and HR 75 beats/minute. Her laboratory results were as follows: HDL-C 64 mg/dL, LDL-C 101 mg/dL, TG 98 mg/dL, and TC 185 mg/dL. Discuss the appropriate next step for …

Write up what is most interesting and most beneficial regarding Online Clinical Correlation. Provide Constructive criticism to how the session could be improved?   I really enjoyed the online clinical correlation because as a group we got to solve complex cases. I thoroughly enjoyed the cases and presentations because it was unique, which forced me to think outside of the box as it is a challenging case to connect a patient coming with a puffy eye and being diagnosed with ALL. I believe in the 5 weeks pediatric rotation, the chance of coming across this type of case is rare but …