Join us for this rapid fire review of systems featuring our top pearls and articles LIVE! from the TriService ACP conference. Matt and Paul serve up their favorite practice changing knowledge food on antibiotics, MRSA, hair loss, dementia, seizures, diabetes, medications for hypertension, foods for constipation, diverticulitis, colon cancer screening, colon polyps, chronic sinusitis, chronic cough, treatment of uterine bleeding, and more!
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Short course antibiotics (5 days or less) is adequate for many common infections like CAP, UTI, Cellulitis, Acute on Chronic Bronchitis (COPD), and even some cases of pyelonephritis (see figure based on the ACP guidance statement with input from #medtwitter) —Lee, Annals 2021.
Made famous by @BradSpellberg on Twitter and his website: https://www.bradspellberg.com/shorter-is-better
@PaulSaxMD’s blog features this list of oral antibiotics with high oral bioavailability (thus achieving high blood levels) –source: Paul Sax’s ID Learning Unit.
NOTE: The entire class of beta-lactam and beta-lactam-like antibiotics (penicillins and cephalosporins) are not on this list!
The Big 3 for hair loss are alopecia areata (the bald spot), androgenic alopecia, and telogen effluvium (the bag of hair). We’d throw in traction alopecia as a 4th common cause. It’s caused by repetitive mechanical tension from pulling hair back, which can loosen hair from the follicles. Patients may develop bumps, redness, and tenderness. Certain professions e.g. ballerinas, gymnasts, and military personnel are prone. Prevention is the best treatment. Topical steroids and antibiotics may be used in some cases (Skin of Color Society).
Topical minoxidil can be used for telogen effluvium, or androgenic alopecia (expert opinion). Counsel patients to use it nightly for 16 weeks to determine efficacy. A period of initial paradoxical shedding may occur. Indefinite use is required to maintain gains.
Lab workup is minimal and can consist of TSH, ferritin, CMP, CBC, and maybe vitamin D. Don’t send an ANA unless lupus is suspected (Telogen effluvium, Uptodate 2021).
Does the person walk and talk slow? Or normal (“fast”)?
“Fast” and younger age = Alzheimer’s vs FTD.
“Fast and older = Alzheimer’s
Slow with vascular risk factors = vascular
Slow with Parkinson features = PD vs Lewy Body dementia (Decide type by earliest symptoms)
As a group, we suck at treating hypertension (Million Hearts). Most adults require two meds (Chobanian, 2008). Recent guidelines by ACP 2017, AHA 2017, ISH 2020, and KDIGO 2021 vary the targets. Here’s Watto’s current take:
Lower is generally better (SPRINT 2015; Zhang, 2021), but for older adults with multiple comorbidities an SBP <150 mmHg is acceptable (ACP 2017). For most other adults an SBP <140 mmHg is acceptable (ACP, AHA, ISH), but <130 mmHg is ideal SBP <130 mmHg (AHA, ISH).
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Listeners will review tops pearls from Curbsiders episodes and practice-changing articles published in 2020-2021
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Williams PN, Watto MF. “#301: LIVE! Top Pearls 2021: A Rapid Fire Review of Systems”. The Curbsiders Internal Medicine Podcast. http://thecurbsiders.com/episode-list Final publishing date, October 25, 2021.
The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.
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