Contributor: Erik Verzemnieks, MD Educational Pearls: INR measures the clotting cascade including factors II, VII, IX, and X Coumadin most commonly elevates the INR, and it is used to monitor the anticoagulant’s effectiveness Liver failure can cause a similar elevation in the INR due to lack of synthesis of factors II, VII, IX, X An…
Read MoreContributor: Don Stader, MD Educational Pearls: Checkpoint inhibition normally helps our body detect abnormal cells and terminate it but cancerous cells often are able to avoid this countermeasure Monoclonal antibodies that bind to checkpoint inhibitors can stop cancerous cells from turning off immunologic T cells and allows the immune system to continue to attack cancers….
Read MoreContributor: Don Stader, MD Educational Pearls: When do we give antiplatelet drugs or anti-coagulation drugs? Arterial issues get antiplatelet therapy Venous issues, or slow flow states, get anticoagulation therapy. High flow areas (arteries) are more prone to platelet clotting while the venous system is more prone to allowing blockages caused by coagulation factors. The main…
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Superior Vena cava syndrome Chief Complaint: Facial Swelling HPI: Patient presents to the emergency department reporting several days of recurrent facial swelling. She states that when she wakes in the morning, starting 3 days ago, she has significant facial swelling. Yesterday there was some extension of the swelling down to her bilateral upper extremities and…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Hemophilia is characterized by bleeding (A /B) A is is 8, B (chrstmas, 9) Hemophilia refers to a group of bleeding disorders caused by a deficiency in a certain clotting factor. The two most common are hemophilia A (caused by a lack of factor VIII), and B (caused by…
Read MoreAuthor: Rachel Brady, MD Educational Pearls: Hypercalcemia of malignancy: Hypercalcemia of malignancy can present with lethargy, muscle weakness, hyperreflexia, altered mental status, cardiac dysrhythmias, and even cardiac arrest. Treatment is based both on calcium level and symptoms Intravenous rehydration is first line treatment Other options include steroids, bisphosphonates and calcitonin. Tumor Lysis Syndrome Occurs due…
Read MoreAuthor: Chris Holmes, MD Educational Pearls: Symptoms commonly seen with mononucleosis are palatal petechiae, posterior cervical lymphadenopathy, inguinal/axillary lymphadenopathy, splenomegaly, and/or atypical lymphocytes > 10% on CBC. Among these, posterior cervical lymphadenopathy and atypical lymphocytes > 10% were the most sensitive (sensitivities of 0.64 and 0.66 respectively). References Welch, JL et al. What Elements Suggest…
Read MoreAuthor: Dylan Luyten, MD Educational Pearls: Most important questions to answer with low potassium are 1. What are their symptoms? 2. Can they take potassium by mouth? Oral repletion is faster, cheaper, and more effective than IV repletion. Give IV potassium when patients have K < 2.5 mmol/L or present with arrhythmias and/or characteristic EKG…
Read MoreAuthor: Nick Hatch, MD Educational Pearls: The sodium-glucose cotransporter in the gut is essential for rehydration. Oral rehydration therapies require an equimolar concentration of glucose and sodium to be effective. ORT has saved millions of lives globally. Consider using ORT in patients with dehydration. Especially useful in resource limited settings. References: Victora CG, Bryce J,…
Read MoreAuthor: Dylan Luyten , MD Educational Pearls: Rare autosomal dominant condition that is often misdiagnosed as a psychiatric illness. Presents as profound muscle weakness with frank paralysis that is often precipitated by vigorous exercise, high carb diet, high sodium load, or by high temperatures. Supplemental potassium can rapidly reverse symptoms. Important to rule out thyrotoxicosis…
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