| Addison disease |
| Cancer |
| Celiac disease |
| Chronic obstructive pulmonary disease |
| Crohn disease |
| Dementia |
| Depression |
| Diabetes |
| Heart failure |
| HIV/AIDS |
| Hypercalcemia |
| Thyroid disease |
| Parkinson disease |
| Peptic ulcer |
| Tuberculosis |
| Ulcerative colitis |
| Irritable bowel disease |
| Clostridium difficile |
Source: Medscape. How should I evaluate weight loss in the elderly?
“Patients who take an overdose of GHB present with a remarkably diminished level of consciousness. Hypothermia, bradycardia, vomiting, and hypotension are other manifestations. In a recent report of several patients who presented with GHB overdose, all were noted to have delirium and transient respiratory depression.
Use of physostigmine should be considered carefully because of its potential dangers. Physostigmine may exacerbate bradyarrhythmias and atrioventricular conduction delays. Seizures have been reported with rapid administration. In addition, its use may precipitate bronchospasm, vomiting, defecation, urination, and excessive salivation (cholinergic crisis).
In light of the potential toxicity of physostigmine, it should be used only in patients in whom GHB ingestion is certain, and physostigmine should be administered slowly (over 2-5 minutes) and intravenously. Physostigmine dose is 2 mg.”
— Mayo Clin Proc 2000
ABC's of Non- GI causes of vomiting
Acute renal failure
Brain (Increased ICP)
Cardiac (Inferior MI)
DKA
Ears (labyrinthitis)
Foreign substances (Tylenol, theo, etc)
Glaucoma
Hyperemesis Gravidarum
Infections (pyelonephritis, meningitis)
Syncope is common in all age groups, and it affects 40% of people during their lifetime
Few people with syncope seek medical attention
Neurally mediated syncope, which is benign, is the most common cause
Cardiac syncope as a result of arrhythmias or structural cardiopulmonary disease is more common with increasing age
Cardiac syncope is associated with increased mortality and must be excluded
Brain imaging, carotid Doppler ultrasound, electroencephalography, and chest radiography are not needed in patients with syncope
Tips for non-specialists
Syncope is the most common cause of transient loss of consciousness
Most cases of neurally mediated syncope can be treated effectively with lifestyle modification and medical reassurance
Transient ischaemic attacks do not present with loss of consciousness
Diagnosis can often be made after a clinical history, physical examination, 12 lead electrocardiogram, and lying or standing blood pressure measurements
Twenty four hour ambulatory electrocardiography monitoring has a low yield and will probably diagnose arrhythmias only in patients who have daily symptoms
Patients with suspected cardiac syncope or atypical neurally mediated syncope (particularly with injury or driving or occupational related implications) need referral to specialist services
An approach to the evaluation and management of syncope in adults -- Parry and Tan 340: c880 -- BMJ
Summary Recommendations for the Primary Care of Solid Organ Transplant Recipients
Medications
1. Check for possible drug interactions of all new medications prescribed.
2. Check immunosuppressant levels 48 to 72 hours after initiation of any new medication expected to affect levels.
Hypertension
1. Target blood pressure is <130/<80 mm Hg for renal and liver transplant recipients and for other transplant recipients with renal disease or other cardiac risk equivalents.
2. The choice of blood pressure agents should be influenced by comorbid conditions, the pathophysiology of hypertension in transplant recipients, and drug effects on immunosuppressant levels.
Hyperlipidemia
1. The target LDL is <100 mg/dL for renal transplant recipients.
2. In the absence of data, PCPs should consider treating other transplant recipients to a target LDL of <100 mg/dL.
3. Statins should be used as first-line therapy.
4. Special attention should be paid to the increased risk of myopathy associated with statin use in the transplant population.
Diabetes
1. Recommendations of the American Diabetic Association should be applied to the transplant population.
Malignancy
1. Transplant recipients should be considered at high risk for all malignancies.
2. PCPs should consider shorter screening intervals.
3. Annual dermatological examinations should screen for skin malignancies.
4. Sunblock with an SPF of 60 or greater should be applied daily to sun-exposed skin surfaces.
5. Patients with newly diagnosed malignancy should be considered for a reduction in immunosuppressants.
Immunizations
1. All patients preparing for transplantation should receive immunizations against tetanus, diphtheria, pertussis, Streptococcus pneumoniae, hepatitis A and hepatitis B.
2. After transplantation, booster immunization should be provided for influenza, tetanus, diphtheria, Streptococcus pneumoniae, and hepatitis A and B.
Contraception
1. Women of child-bearing age should be counseled about the need for contraception after transplantation.
2. Low-dose oral contraceptive agents should be considered for women who have diabetes, hypertension, or hyperlipidemia and do not have contraindications for their use.
3. Women should be counseled about the decrease in contraceptive efficacy of intrauterine devices after transplantation.
ScienceDirect - The American Journal of Medicine : Primary Care of the Transplant Patient
Clinicians & Facebook: The Boundaries of Professionalism
Anne Meneghetti, MD
Director, Clinical CommunicationsImagine a series of photos showing you in progressive stages of drunkenness at a party. Imagine a quote in which you gripe about a particularly difficult day at work, using robustly colorful language. Imagine the reaction from patients, colleagues, or prospective employers as they view these on Facebook. A study of medical trainees1 found that nearly half had a Facebook account; 70% of them had posted photos showing alcohol, some with implied excess. Examples of foul language were present, as well as comments such as, “Physicians looking for trophy wives in training.”
In light of the unprecedented access to personal information on the web, consider the following if you choose to create a digital identity on Facebook:
1.
Scrupulously examine both privacy and profile settings, limiting access only to “friends” you accept; “friends of friends” might be patients. Limit who can “tag” a photo of you or post on your personal page. Ignore “friend” requests from patients; explain your policy at the next face-to-face visit.2.
If you choose to create a separate professional identity (Facebook business or group page), consider that page “fans” may perceive it as a direct hotline to you. Privacy concerns, lack of 24/7 monitoring of messages, medical recordkeeping, and misuse of the page for emergency inquiries are serious issues.3.
If you come across information about a patient through social networking sites, do not record it in the medical record without the patient’s consent.Patients understand that clinicians are human beings with lives outside the office, and social media serves to personalize our profession. Maintaining a professional online persona preserves the mutual trust and respect we share with patients.
1Thompson LA, J Gen Intern Med. 2008 Jul;23(7):954-7.
Epocrates Pulse: Social Media and Medicine
