wikidoc - User contributions [en]

WBR1943

2021-04-26T16:58:57Z

William J Gibson:

{{WBRQuestion
|QuestionAuthor=William J Gibson
|ExamType=ABIM Cardiology
|MainCategory=Arrhythmias
|MainCategory=Arrhythmias
|MainCategory=Arrhythmias
|MainCategory=Arrhythmias
|MainCategory=Arrhythmias
|MainCategory=Arrhythmias
|MainCategory=Arrhythmias
|MainCategory=Arrhythmias
|MainCategory=Arrhythmias
|MainCategory=Arrhythmias
|MainCategory=Arrhythmias
|MainCategory=Arrhythmias
|MainCategory=Arrhythmias
|MainCategory=Arrhythmias
|Prompt=Here is a prompt
|Explanation=Explanation is here.
|AnswerA=One possible answer A
|AnswerAExp=Some expl
|AnswerB=One possible answer B
|AnswerBExp=ASDfansfgs
|AnswerC=One possible answer C
|AnswerCExp=sdfgdsfht
|AnswerD=One possible answer D
|AnswerDExp=dsfghdsgjh
|AnswerE=One possible answer E
|AnswerEExp=dsfhgjftiuty
|EducationalObjectives=sfghdyw89789
|RightAnswer=B
|WBRKeyword=Cardiology
|Approved=No
}}

WBR1943

2021-03-03T20:49:03Z

William J Gibson: Created page with "{{WBRQuestion |QuestionAuthor=William J Gibson |ExamType=ABIM Cardiology |Prompt=Here is a prompt |Explanation=Explanation is here. |AnswerA=One possible answer A |AnswerAExp=..."

{{WBRQuestion
|QuestionAuthor=William J Gibson
|ExamType=ABIM Cardiology
|Prompt=Here is a prompt
|Explanation=Explanation is here.
|AnswerA=One possible answer A
|AnswerAExp=Some expl
|AnswerB=One possible answer B
|AnswerBExp=ASDfansfgs
|AnswerC=One possible answer C
|AnswerCExp=sdfgdsfht
|AnswerD=One possible answer D
|AnswerDExp=dsfghdsgjh
|AnswerE=One possible answer E
|AnswerEExp=dsfhgjftiuty
|EducationalObjectives=sfghdyw89789
|RightAnswer=B
|WBRKeyword=Cardiology
|Approved=No
}}

WBR0052

2020-10-27T14:26:00Z

William J Gibson:

{{WBRQuestion
|QuestionAuthor=William J Gibson (Reviewed by {{Rim}} and Yazan Daaboul)
|ExamType=USMLE Step 1
|MainCategory=Microbiology
|SubCategory=General Principles, Infectious Disease
|MainCategory=Microbiology
|SubCategory=General Principles, Infectious Disease
|MainCategory=Microbiology
|SubCategory=General Principles, Infectious Disease
|MainCategory=Microbiology
|MainCategory=Microbiology
|MainCategory=Microbiology
|MainCategory=Microbiology
|SubCategory=General Principles, Infectious Disease
|MainCategory=Microbiology
|SubCategory=General Principles, Infectious Disease
|MainCategory=Microbiology
|SubCategory=General Principles, Infectious Disease
|MainCategory=Microbiology
|SubCategory=General Principles, Infectious Disease
|MainCategory=Microbiology
|SubCategory=General Principles, Infectious Disease
|MainCategory=Microbiology
|SubCategory=General Principles, Infectious Disease
|MainCategory=Microbiology
|MainCategory=Microbiology
|SubCategory=General Principles, Infectious Disease
|Prompt=A 6-year-old African American boy is brought to the emergency department for severe abdominal pain. He reports his abdomen is stiff and bloated with diffuse pain that is most severe in the left upper quadrant. The patient has had a previous similar episode in the past. His past medical history is also significant for dactylitis at the age of 18 months. Further questioning reveals that his older sister suffers from similar painful episodes that also require hospitalizations. After supportive measures, this patient is requested to receive a vaccine for an encapsulated, catalase-positive, gram-negative rod. What moiety is used in this vaccine?
|Explanation=The patient in this vignette suffers from [[sickle cell anemia]]. Sickle cell anemia is an [[autosomal recessive]] hemoglobinopathy that mainly affects patients of African American and Middle Eastern ancestry. Patients with sickle cell anemia suffer from recurrent vaso-occlusive crisis, splenic sequestration crisis, [[aplastic crisis]] and hemolytic crisis. All of these clinical scenarios are caused by aggregation of sickled erythrocytes that tend to be brought on by conditions of stress, infection, and dehydration. In this vignette, the patient is suffering from a splenic sequestration crisis. Because of its narrow vessels and function in clearing defective [[red blood cells]], the [[spleen]] is frequently affected and is usually infarcted before the end of childhood in individuals suffering from [[sickle cell anemia]]. Splenic sequestration crises are acute, painful episodes that cause congestive splenomegaly that eventually lead to autosplenectomy following repeated episodes. During these episodes, the splenic sinusoids and gates would open at the same time resulting in sudden pooling of the blood into the spleen that causes a circulatory defect leading to sudden [[hypovolemia]]. The abdomen becomes bloated and very hard on palpation. Splenic sequestration crises are considered an emergency.

Surgical splenectomy may be required in some cases, while others are closely followed-up. Both cases are still characterized by [[functional asplenia]] and patients are advised to receive [[vaccine]]s against encapsulated organisms including ''[[Streptococcus pneumoniae]]'', ''[[Neisseria meningitidis]]'', and ''[[Haemophilus influenzae]]'' type B. ''[[Haemophilus influenzae]]'' type B is an encapsulated, catalase-positive, [[gram negative]] rod which can cause severe [[meningitis]] in unvaccinated infants and children. The vaccine for this organism is a conjugate vaccine that uses the bacterial capsular polysaccharide polyribosylribitol phosphate (PRP) conjugated with a protein to stimulate long-term [[humoral immunity]].
|AnswerA=Polyribosylribitol phosphate
|AnswerAExp=The vaccine for ''[[Haemophilus influenzae]]'' type B is a conjugate vaccine that uses the bacterial capsular polysaccharide polyribosylribitol phosphate (PRP) conjugated with a protein to stimulate long term [[humoral immunity]].
|AnswerB=Peptidoglycan
|AnswerBExp=[[Peptidoglycan]] composes the membrane of most bacteria. It is not used in the ''[[Haemophilus influenzae]]'' type B vaccine.
|AnswerC=Protein A
|AnswerCExp=[[Protein A]] is a virulence factor of ''[[S. aureus]]'' which binds to the Fc portion of Ig and helps to prevent opsonization and phagocytosis. It is not used in the ''[[Haemophilus influenzae]]'' type B vaccine.
|AnswerD=Lipid A
|AnswerDExp=[[Lipid A]] is a part of [[endotoxin]], a lipopolysaccharide which is a highly immunogenic component of the cell wall of gram-negative bacteria. It is not used in the ''[[Haemophilus influenzae]]'' type B vaccine.
|AnswerE=M protein
|AnswerEExp=[[M protein]] is a virulence factor of ''[[Streptococcus pyogenes]]'' that helps prevent [[phagocytosis]]. It is not used in the ''[[Haemophilus influenzae]]'' type B vaccine.
|EducationalObjectives=The vaccine for this ''[[Haemophilus influenzae]]'' B is a conjugate vaccine that uses the bacterial capsular polysaccharide polyribosylribitol phosphate conjugated with a [[protein]] to stimulate long-term humoral immunity.
|References=Vadheim CM, Greenberg DP, Marcy SM, et al. Safety evaluation of PRP-D Haemophilus influenzae type b conjugate vaccine in children immunized at 18 months of age and older: follow-up study of 30,000 children. ''Pediatr Infect Dis J''. 1990;9(8):555-61.
First Aid 2014 page 137
|RightAnswer=A
|WBRKeyword=Microbiology, Bacteria, Vaccine, Sickle, Sickle cell, Sickle cell anemia, african american, Sickle cell disease, PRP, hemophilus, infleunzae, autosplenectomy, splenectomy, dactylitis
|Approved=Yes
}}

Form:WBRQuestion

2020-10-26T23:40:28Z

William J Gibson:

__NOTOC__
<noinclude>
==WikiDoc Board Review Question Form==
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|<br />
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|<br />
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<div id="BoardReview">
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|-
!<br />
|<br />
|-
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|}
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<div id="BoardReviewFC">
{| class="formtable"
!Specialty:
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|-
!<br />
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|-
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Form:WBRQuestion

2020-10-26T23:36:50Z

William J Gibson:

__NOTOC__
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{| class="formtable"
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! Exam Type:
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|}
<div id="USMLE1">
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! Main Category:
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|-
! Sub Category:
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|}
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<div id="USMLE2">
{| class="formtable"
! Main Category:
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|}
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<div id="USMLE3">
{| class="formtable"
! Main Category:
| Select All That Apply:<br />{{{field|MainCategory|property=MainCategory|input type=checkboxes|values=Community Medical Health Center, Primary Care Office, Inpatient Facilities, Emergency Room}}}
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|}
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<div id="MCAT">
{| class="formtable"
! Specialty/Organ System:
| Select All That Apply:<br />{{{field|MainCategory|property=MainCategory|input type=checkboxes|values=Biology, Cell, Enzymes, Microbiology, Cellular Metabolism, Reproduction, Embryology, Musculoskeletal System, Digestive System , Excretory System, Respiratory System, Skin, Circulatory System, Immune System, Homeostasis, Endocrine System, Nervous System , Genetics, Evolution, Organic Chemistry, Nomenclature, Bonding/Structure, Isomers, Alkanes, AlkenesAlkynes, Haloalkanes, Aromatic Compounds, Alcohols, Ethers, Aldehydes , Ketones, Carboxylic Acid, Carboxylic Acid Derivatives, Amines, Nitrogen Containing Compounds, Purification, Spectroscopy, Separations, Carbohydrates, Amino Acids, Peptides, Proteins, Nucleic, Acids, Chemistry, Atomic Structure, Periodic Table, Phases, Gases, Bonding, Stoichiometry, Kinetics, Thermochemistry, Phases, Solutions, Acids and Bases, Redox Reactions, Electrochemistry, Physics, Kinematics, Fluids, Solids, Newtonian Mechanics, Momentum, Energy, Thermodynamics, Electrostatics, Magnetism, DC Circuits, AC Circuits, Periodic Motion, Waves, Sound, Optics, Light, Atomic Phenomena, Nuclear Phenomena}}}
|}
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<div id="ABNS">
{| class="formtable"
! ABNS Keyword:
| Select All That Apply:<br />{{{field|MainCategory|property=MainCategory|input type=checkboxes|values=Neuroanatomy, Neurobiology, Neuropathology, Neuroimaging, Neurology, Neurosurgery, Fundamental Clinical Skills, Core Competencies}}}
|}
</div>

<div id="ABIMCardiology">
{| class="formtable"
! ABNS Keyword:
| Select All That Apply:<br />{{{field|MainCategory|property=MainCategory|input type=checkboxes|values=Arrhythmias,Coronary Artery Disease,Heart Failure and Cardiomyopathy, Valvular Disease,Pericardial Disease,Congenital Heart Disease,Vascular Diseases,Systemic Hypertension and Hypotension,Pulmonary Circulation Disorders,Systemic Disorders Affecting the Circulatory System,Normal Cardiovascular Anatomy and Physiology}}}
|}
</div>

<div id="SurgeryShelf">
{| class="formtable"
! Category:
| Select All That Apply:<br />{{{field|MainCategory|property=MainCategory|input type=checkboxes|values=Breast, Cardiothoracic, Endocrine, General Principles, Lower Gastrointestinal tract, Neurosurgery, Ophthalmology, Orthopedics, Otolaryngology, Pancreatic and Hepatic, Pediatric surgery, Skin and soft tissue, Trauma and Burns, Upper Gastrointestinal tract, Urology}}}
|<br />
|-
! Sub Category:
| Select All That Apply:<br />{{{field|SubCategory|property=SubCategory|input type=checkboxes|values=Diagnosis,Management,Mechanisms,Promoting Health and Health Maintenance}}}

|}

</div>

<div id="RadiationOncology">
{| class="formtable"
! Category:
| Select All That Apply:<br />{{{field|MainCategory|property=MainCategory|input type=checkboxes|values=Breast, Central Nervous System, Digestive System, Head and Neck, Genitourinary sites, Gynecologic sites, Lymphoma and Myeloma, Musculoskeletal sites, Pediatric (Non-CNS), Palliation, Skin, Thorax, General principles}}}
|<br />
|-
! Sub Category:
| Select All That Apply:<br />{{{field|SubCategory|property=SubCategory|input type=checkboxes|values=Diagnosis, Disease knowledge, General principles, Management}}}

|}

</div>

<div id="BoardReview">
{| class="formtable"
!Specialty:
| Select All That Apply:<br />{{{field|MainCategory|property=MainCategory|input type=checkboxes|values=Adolescent Medicine, Advanced Heart Failure and Transplant Cardiology, Allergy & Immunology, Cardiovascular Disease, Clinical Cardiac Electrophysiology, Critical Care Medicine, Endocrinology, Diabetes & Metabolism, Gastroenterology, Geriatric Medicine, Hematology, Hospice & Palliative Medicine, Hospital Medicine, Focused Practice, Infectious Disease, Internal Medicine, Interventional Cardiology, Medical Oncology, Nephrology, Pulmonary Disease, Rheumatology, Sleep Medicine, Sports Medicine, Transplant Hepatology}}}
|-
!<br />
|<br />
|-
!Subspeciality:
|Select All That Apply:<br />{{{field|SubCategory|property=SubCategory|input type=checkboxes|values=Anesthesiology, Dermatology, Emergency Medicine, Emergency Medicine/Critical Care Medicine, Family Medicine, Medical Genetics, Neurology, Nuclear Medicine, Pediatrics, Physical Medicine & Rehab, Preventative Medicine, Psychiatry}}}
|}
</div>
<div id="USMLE1FC">
{| class="formtable"
! Main Category:
| Select All That Apply:<br />{{{field|MainCategory|property=MainCategory|input type=checkboxes|values=Anatomy, Behavioral Science/Psychiatry, Biochemistry, Biostatistics/ Epidemiology, Embryology, Ethics, Genetics, Histology, Immunology, Microbiology, Pathology, Pathophysiology, Pharmacology, Physiology}}}
|-
!<br />
|<br />
|-
! Sub Category:
| Select All That Apply:<br />{{{field|SubCategory|input type=checkboxes|property=SubCategory|values=Cardiology, Dermatology, Endocrine, Gastrointestinal, Genitourinary, Head and Neck, Hematology, Musculoskeletal/Rheumatology, Neurology, Oncology, Pulmonology, Reproductive, Renal, Vascular, General Principles}}}
|}
</div>
<div id="USMLE2FC">
{| class="formtable"
! Main Category:
| Select All That Apply:<br />{{{field|MainCategory|input type=checkboxes|property=MainCategory|values=Internal medicine, Surgery, OB/GYN, Pediatrics, Psychiatry}}}
|-
!<br />
|<br />
|-
! Sub Category:
| Select All That Apply:<br />{{{field|SubCategory|property=SubCategory|input type=checkboxes|values=Allergy/Immunology, Cardiovascular, Dermatology, Endocrine, Gastrointestinal, Hepatology, Genitourinary, Head and Neck, Hematology, Infectious Disease, Musculoskeletal/Rheumatology, Neurology, Obstetrics & Gynecology, Oncology, Ophthalmology, Pediatrics, Poisoning, Preventive Medicine, Psychiatry, Respiratory, Surgery, Biostatistics/ Epidemiology, Ethics, Electrolytes, Genetics, Miscellaneous}}}
|}
</div>
<div id="USMLE3FC">
{| class="formtable"
! Main Category:
| Select All That Apply:<br />{{{field|MainCategory|property=MainCategory|input type=checkboxes|values=Community Medical Health Center, Primary Care Office, Inpatient Facilities, Emergency Room}}}
|-
!<br />
|<br />
|-
! Sub Category:
| Select All That Apply:<br />{{{field|SubCategory|property=SubCategory|input type=checkboxes|values=Allergy/Immunology, Cardiovascular, Dermatology, Endocrine, Gastrointestinal, Hepatology, Genitourinary, Head and Neck, Hematology, Infectious Disease, Musculoskeletal/Rheumatology, Neurology, Obstetrics & Gynecology, Oncology, Ophthalmology, Pediatrics, Poisoning, Preventive Medicine, Psychiatry, Respiratory, Surgery, Biostatistics/ Epidemiology, Ethics, Electrolytes, Genetics, Miscellaneous}}}
|}
</div>
<div id="MCATFC">
{| class="formtable"
! Specialty/Organ System:
| Select All That Apply:<br />{{{field|MainCategory|property=MainCategory|input type=checkboxes|values=Biology, Cell, Enzymes, Microbiology, Cellular Metabolism, Reproduction, Embryology, Musculoskeletal System, Digestive System , Excretory System, Respiratory System, Skin, Circulatory System, Immune System, Homeostasis, Endocrine System, Nervous System , Genetics, Evolution, Organic Chemistry, Nomenclature, Bonding/Structure, Isomers, Alkanes, AlkenesAlkynes, Haloalkanes, Aromatic Compounds, Alcohols, Ethers, Aldehydes , Ketones, Carboxylic Acid, Carboxylic Acid Derivatives, Amines, Nitrogen Containing Compounds, Purification, Spectroscopy, Separations, Carbohydrates, Amino Acids, Peptides, Proteins, Nucleic, Acids, Chemistry, Atomic Structure, Periodic Table, Phases, Gases, Bonding, Stoichiometry, Kinetics, Thermochemistry, Phases, Solutions, Acids and Bases, Redox Reactions, Electrochemistry, Physics, Kinematics, Fluids, Solids, Newtonian Mechanics, Momentum, Energy, Thermodynamics, Electrostatics, Magnetism, DC Circuits, AC Circuits, Periodic Motion, Waves, Sound, Optics, Light, Atomic Phenomena, Nuclear Phenomena}}}
|}
</div>
<div id="BoardReviewFC">
{| class="formtable"
!Specialty:
| Select All That Apply:<br />{{{field|MainCategory|property=MainCategory|input type=checkboxes|values=Adolescent Medicine, Advanced Heart Failure and Transplant Cardiology, Allergy & Immunology, Cardiovascular Disease, Clinical Cardiac Electrophysiology, Critical Care Medicine, Endocrinology, Diabetes & Metabolism, Gastroenterology, Geriatric Medicine, Hematology, Hospice & Palliative Medicine, Hospital Medicine, Focused Practice, Infectious Disease, Internal Medicine, Interventional Cardiology, Medical Oncology, Nephrology, Pulmonary Disease, Rheumatology, Sleep Medicine, Sports Medicine, Transplant Hepatology}}}
|-
!<br />
|<br />
|-
!Subspeciality:
|Select All That Apply:<br />{{{field|SubCategory|property=SubCategory|input type=checkboxes|values=Anesthesiology, Dermatology, Emergency Medicine, Emergency Medicine/Critical Care Medicine, Family Medicine, Medical Genetics, Neurology, Nuclear Medicine, Pediatrics, Physical Medicine & Rehab, Preventative Medicine, Psychiatry}}}
|}
</div>
{| class="formtable"
! Question:
| {{{field|Prompt|input type=textarea}}}
|-
! Overall Explanation:
| {{{field|Explanation|input type=textarea}}}
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! Answer A:
| {{{field|AnswerA|property=AnswerA|size=50}}}
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| {{{field|AnswerAExp|property=AnswerAExp|input type=textarea}}}
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! Answer B:
| {{{field|AnswerB|property=AnswerB|size=50}}}
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! Answer B Explanation:
| {{{field|AnswerBExp|property=AnswerBExp|input type=textarea}}}
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! Answer C:
| {{{field|AnswerC|property=AnswerC|size=50}}}
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! Answer C Explanation:
| {{{field|AnswerCExp|property=AnswerCExp|input type=textarea}}}
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! Answer D:
| {{{field|AnswerD|property=AnswerD|size=50}}}
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! Answer D Explanation:
| {{{field|AnswerDExp|property=AnswerDExp|input type=textarea}}}
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! Answer E:
| {{{field|AnswerE|property=AnswerE|size=50}}}
|-
! Answer E Explanation:
| {{{field|AnswerEExp|property=AnswerEExp|input type=textarea}}}
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! Educational Objectives:
| {{{field|EducationalObjectives|input type=textarea}}}
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! References:
| {{{field|References|input type=textarea}}}
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! Right Answer:
| {{{field|RightAnswer|input type=dropdown|values=A,B,C,D,E}}}
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| {{{field|WBRKeyword|input type=text with autocomplete|list}}}
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! Linked Questions (input WBRIDs of linked questions in here, including the current question. Separate by commas. For example: WBR0101, WBR0102, WBR0103. Leave blank if unlinked):
| {{{field|Linked|input type=textarea}}}
|-
! Order in Linked Questions (for example 2 for the second question in a set):
| {{{field|LinkedOrder|input type=textarea}}}
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| {{{field|Approved|property=Approved|input type=checkbox}}}
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{{{standard input|save}}} {{{standard input|preview}}} {{{standard input|changes}}} {{{standard input|cancel}}}
</includeonly>

WBR0072

2020-10-26T23:27:44Z

William J Gibson:

{{WBRQuestion
|QuestionAuthor=Anonymous (Reviewed by Will Gibson and Yazan Daaboul)
|ExamType=USMLE Step 1
|MainCategory=Pharmacology
|SubCategory=Oncology
|MainCategory=Pharmacology
|SubCategory=Oncology
|MainCategory=Pharmacology
|SubCategory=Oncology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Oncology
|MainCategory=Pharmacology
|SubCategory=Oncology
|MainCategory=Pharmacology
|SubCategory=Oncology
|MainCategory=Pharmacology
|SubCategory=Oncology
|MainCategory=Pharmacology
|SubCategory=Oncology
|MainCategory=Pharmacology
|SubCategory=Oncology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Oncology
|Prompt=A new chemotherapeutic drug of unclear mechanism is under investigation. After treatment with the drug, hamster ovary cells are found to be arrested in metaphase. Further studies show that the drug and paclitaxel both bind to beta-tubulins and promote stabilization of microtubules. Which of the following drugs is most likely to have the same mode of action?
|Explanation=When hamster ovary cells are incubated with the investigational drug, cell division arrests in [[metaphase]]. In the absence of an intact mitotic spindle, duplicated chromosomes cannot correctly align along the division plate and may result in apoptosis. [[Paclitaxel]] differs from the [[vinca alkaloids]] and colchicine derivatives in that it binds to a different [[tubulin]] site and promotes rather than inhibits microtubule formation. The taxanes have a central role in treating ovarian, breast, lung, gastrointestinal, genitourinary, and head and neck cancers.
|AnswerA=Colchicine
|AnswerAExp=[[Colchicine]] inhibits [[microtubule]] polymerization by binding to tubulin and functions as a mitotic poison. The mitosis-inhibiting function of colchicine has been used in karyotype studies. Arresting cells in metaphase by adding colchicine facilitates visualization of chromosomes under a light microscope. Apart from inhibiting mitosis, colchicine also inhibits neutrophil motility and produces an anti-inflammatory effect.
|AnswerB=Estramustine
|AnswerBExp=[[Estramustine]] is made from coupling of [[estradiol]] and mustard through a carbamate link. However, estramustine has a weak DNA-alkylating action. In fact, it binds to [[beta-tubulin]] and microtubule-associated proteins and leads to microtubule disassembly. Estramustine is used primarily for the treatment of metastatic or locally advanced hormone refractory [[prostate cancer]].
|AnswerC=Irinotecan
|AnswerCExp=[[Irinotecan]] and [[topotecan]] are [[camptothecin analogs]] approved for clinical use in colorectal, ovarian, and small cell lung cancer. Camptothecins stabilize the normally transient DNA-topoisomerase I cleavable complex and cause an irreversible double-strand DNA break during replication.

DNA topoisomerases are nuclear enzymes that reduce torsional stress in supercoiled DNA, allowing selected regions of DNA to become sufficiently untangled for replication, repair, and transcription. Camptothecin analogs inhibit the function of topoisomerase I, while anthracyclines, epipodophyllotoxins and acridines inhibit topoisomerase II.
|AnswerD=Ixabepilone
|AnswerDExp=The [[epothilones]] resemble taxanes in that they bind to beta-tubulin and trigger microtubule nucleation and cell-cycle arrest at the G2-M interface. Epothilones bind to a site distinct from that of taxanes. [[Ixabepilone]] is approved for metastatic [[breast cancer]] treatment.
|AnswerE=Vincristine
|AnswerEExp=The vinca alkaloids, in common with other drugs such as colchicine, podophyllotoxin, the taxanes, and the epothilones, block cells in mitosis. Their mechanism of action is to bind specifically to beta-tubulin and to block its polymerization with alpha-tubulin into microtubules.
|EducationalObjectives=Ixabepilone binds to beta-tubulin to stabilize microtubules and arrest cell division.
|References=Denduluri N, Low JA, Lee JJ, et al. Phase II trial of ixabepilone, an epothilone B analog, in patients with metastatic breast cancer previously untreated with taxanes. ''J Clin Oncol''. 2007;25(23):3421-7.

First Aid 2014 page 78
|RightAnswer=D
|WBRKeyword=Chemotherapy, Pharmacology, Cancer, Cell cycle, Microtubule, Cell growth, Breast cancer, taxane, ixabepilone, paclitaxel, mitosis, cell, cycle
|Approved=Yes
}}

User talk:WikiDocNick

2020-07-04T15:40:37Z

William J Gibson: Welcome!

'''Welcome to ''wikidoc''!'''
We hope you will contribute much and well.
You will probably want to read the [https://www.mediawiki.org/wiki/Special:MyLanguage/Help:Contents help pages].
Again, welcome and have fun! [[User:William J Gibson|William J Gibson]] ([[User talk:William J Gibson|talk]]) 15:40, 4 July 2020 (UTC)

User:WikiDocNick

2020-07-04T15:40:37Z

William J Gibson: Creating user page for new user.

Medical doctor, General Medicine Degree
Graduated Masaryk University, Faculty of Medicine, Brno, Czech Republic
Internal Medicine Internship
Diagnosed specific medical conditions based on observation, physical examination, wellness history, and patient concerns.
Collaborated with attending physicians and other residents when delivering efficient medical care in inpatient and outpatient setting.
Attended public health clinic as volunteer.

User talk:Nazmahanif

2020-07-04T15:17:18Z

William J Gibson: Welcome!

User:Nazmahanif

2020-07-04T15:17:18Z

William J Gibson: Creating user page for new user.

I am a medical graduate from Pakistan. I am ECFMG certified and I have almost 4 years of work experience in Pakistan and in US. I intend to pursue internal medicine residency in the US. Currently, I am working on two research projects on multiple myeloma. I have written an article on chronic iron deficiency which is to be indexed in PubMed in near future. I have also completed and obtained certification for four CITI program courses.

User talk:Andrew.hinkle

2018-12-18T10:38:27Z

William J Gibson: Welcome!

User:Andrew.hinkle

2018-12-18T10:38:27Z

William J Gibson: Creating user page for new user.

I am a second year medical student at Tulane University with a variety of different professional interests. I am originally from Seattle, Washington but I've really enjoyed living in New Orleans and exploring the culture the city has to offer. While I am undecided about exactly what I would like to do after medical school I am interested in different surgical specialties and I look forward to exploring those more in the coming years.

User talk:JdmChm2010

2018-12-12T10:53:06Z

William J Gibson: Welcome!

User:JdmChm2010

2018-12-12T10:53:06Z

William J Gibson: Creating user page for new user.

I currently serve as the Program Director for the WMed EMS Fellowship Program in Kalamazoo MI. Additionally, I have a 0.1FTE through my faculty position at the medical school to serve as the Medical Director for the Allegan County Medical Control Authority, a pseudo governmental authority for oversight of EMS services in the county. When not at the school, I serve as a FF and MFR and EMS Coordinator for the Richland Township FD.

User talk:Devcon

2018-12-12T10:52:53Z

William J Gibson: Welcome!

User:Devcon

2018-12-12T10:52:53Z

William J Gibson: Creating user page for new user.

I don't feel comfortable publishing such information. I just am a medical student from the Mid-west who is trying to go through as many Step 1 questions as possible.
I don't feel comfortable publishing such information. I just am a medical student from the Mid-west who is trying to go through as many Step 1 questions as possible.
I don't feel comfortable publishing such information. I just am a medical student from the Mid-west who is trying to go through as many Step 1 questions as possible.

User talk:Locklear.joseph

2018-12-12T10:51:46Z

William J Gibson: Welcome!

User:Locklear.joseph

2018-12-12T10:51:46Z

William J Gibson: Creating user page for new user.

I'm an incoming M1. I'm eager to begin my journey through medicine. I'm looking for the best resources to ensure that I thrive in my school's curriculum on my way to becoming the best physician I can possibly be. I have an open mind and use positive criticism as a way to improve my weaknesses.

User talk:PPK711

2018-12-12T10:51:44Z

William J Gibson: Welcome!

User:PPK711

2018-12-12T10:51:44Z

William J Gibson: Creating user page for new user.

Did MBBS and MD, PATHOLOGY from Grant Medical College, Under Bombay University.
Dessertation work was on Electron microscopy of Glomerular Diseases.
Worked as Professor of Pathology at SRM Medical College, Kattankulathur, Tamil Nadu.
Before that as Lecturer in Pathology at Grant medical college and BJ medical College. As Associate professor and Professor at DY Patil Medical College.
Presently working as specialist Hematology at PMS Hospital, Balgurashi, KSA
Interested in academic Pathology.

User talk:Damhindi1

2018-12-12T10:50:38Z

William J Gibson: Welcome!

User:Damhindi1

2018-12-12T10:50:38Z

William J Gibson: Creating user page for new user.

Grew up from a small town in Nigeria, Katsina ala where i started my primary school, later moved to a state capital Makurdi i completed my secondary education, growing up i wanted to become a fine artist because i was talented in drawing, my dad wanted me studying engineering, after reading the book written by ben carson gifted hands, it changed my thinking and made me motivated in becoming a neurosurgeon. today i have completed my medical education and am seeking a residency program in neurosurgery, i have attend many international conferences and have written many medical publications. I was retained as a lecturer at my medical school as a Lecturer, David Tvildiani Medical University Tbilisi Georgia, i also Lecter at other university New vision university tbilisi Georgia, i love travelling, adventure.

User talk:Francesca Whitfield

2018-12-12T10:50:12Z

William J Gibson: Welcome!

User:Francesca Whitfield

2018-12-12T10:50:12Z

William J Gibson: Creating user page for new user.

Hello! My name is Francesca Whitfield and I am so excited to be a part of this team and go through this experience. I am an alumna from the University of Virginia with a B.A. in sociology. I am currently working on applying to graduate school to pursue my MPH degree and from there, hopefully, my M.D. degree. I'm excited to work on this project and take in as much information as I can as I believe this will help me tremendously in my future endeavors towards my higher education. I'm also looking forward to building bridges with great people and learning great tools of professionalism and medical writing.

User talk:Vweprinsky

2018-12-12T10:48:42Z

William J Gibson: Welcome!

User:Vweprinsky

2018-12-12T10:48:42Z

William J Gibson: Creating user page for new user.

I attended the University of Virginia and received a degree in Human Biology in 2017. At the University of Virginia I participated in the Peer Health Educator program as an intern and participated in basic science researching at UVA's Medical School salmonella and other gram-negative bacteria and the effects that the BAI1 gene has on recognition, uptake, and killing. I was a full time Urology scribe for 2 months before matriculating at Tulane University School of Medicine in 2017. I am currently in my second year at Tulane and I lead the sexual health elective for medical students and am on the board of NOARHP, an organization that teaches sex education to elementary through high school students in the New Orleans community. In addition to my MD, I am pursuing a Masters in Surgical Anatomy through Tulane School of Medicine.

Ventricular Tachycardia (Assessment and Plan)

2018-10-14T22:49:21Z

William J Gibson:

Author: [[User:William J Gibson|William J Gibson MD,PhD]]

<nowiki>#</nowiki>Ventricular Tachycardia

Differential includes: SVT with aberrancy, SVT with pre-excitation, pacemaker mediated tachycardia.

Things to look for on baseline EKG: bundle branch block, QTc, Q-wave (-> scar), WPW, epsilon wave (-> ARVD), Brugada pattern

Monomorphic VT more commonly associated with scar. Polymorphic VT associated with ischemia.

Management:

- Medication review (QTc prolonging meds increase risk of polymorphic VT, Class IC antiarrhythmics)

-If unstable --> ACLS (including defibrillation)

-If stable: start either amiodarone 150 mg IV, then drip at 1 mg/min for 6 hours, then 0.5 mg/min for 18 hours or lidocaine 100 mg IV, then drip at 1 mg/ min [check levels]

-Replete electrolytes (K > 4, Mg > 2): give mag sulfate 2g-4g immediately if looks like Torsades

Ventricular Tachycardia (Assessment and Plan)

2018-10-14T22:46:41Z

William J Gibson: Initialize VT page

Hypercalcemia (Assessment and Plan)

2018-10-01T21:44:26Z

William J Gibson: Created page with "Author: William J Gibson MD, PhD <nowiki>#</nowiki>Hypercalcemia Corrected Ca = Serum Ca + 0.8 x (4-Alb) Diagnostic approach: Initial labs: Get..."

Author: [[User:William J Gibson|William J Gibson MD, PhD]]

<nowiki>#</nowiki>Hypercalcemia

Corrected Ca = Serum Ca + 0.8 x (4-Alb)

Diagnostic approach:

Initial labs: Get serum PTH, ionized calcium, 1,25(OH)D, 25(OH)D.

High PTH: Primary hPTH, FHH (check 24H urine Ca/Cr ratio), tertiary hPTH

Low PTH:

PTHrP-driven: Malignancy (lung, breast, RCC)

High 1,25(OH)D: Granulomatous disease (TB, sarcoid), lymphoma

High 25(OH)D: Vit D toxicity

Normal labs: Multiple myeloma, milk-alkali, hypothyroidism, adrenal insufficiency, pheo, thiazides, lithium

Treatment:

- If mild: conservative tx, encourage PO, oral phos repletion

- IV fluids (NS bolus, drip), pts typically dehydrated

- Calcitonin 4-8U/kg SC BID for 48hrs

- Bisphosphonates (zoledronate preferred vs pamidronate except in MM), caution if CKD

- Consider Denosumab (anti-RANKL) if refractory to bisphos

- Primary hyperPTH: surg curative. If poor candidate, cinacalcet, bisphos, tamox.

- If life-threatening: HD

Assessment and Plan

2018-10-01T21:31:57Z

William J Gibson:

Welcome to the Assessment and Plan project page.

== Cardiology: ==
[[Acute Coronary Syndrome (Assessment and Plan)|Acute Coronary Syndrome]]

CHF - [[HFrEF exacerbation (Assessment and Plan)|HFrEF exacerbation]]

[[Syncope (Assessment and Plan)|Syncope]]

== Endocrine: ==

== Hematology: ==
[[Macrocytic anemia (Assessment and Plan)|Macrocytic anemia]]

== Oncology: ==
[[Fever and Neutropenia (Assessment and Plan)|Fever and Neutropenia]]

== Pulmonary: ==

== Other ==
[[Lactic acidosis (Assessment and Plan)|Lactic acidosis]]

== Assessment and Plan Project team ==
Project Leader: [[User:William J Gibson|William J Gibson MD, PhD]]

== Pages to add ==
HFpEF exacerbation

Ventricular Assist Device Evaluation (LVAD, BiVAD evaluation)

Cardiac Transplant Evaluation

[[Pulmonary embolism (Assessment and Plan)|Pulmonary embolism]]

Tumor lysis syndrome

[[Microcytic anemia (Assessment and Plan)|Microcytic anemia]]

[[Anemia (Assessment and Plan)|Anemia]]

[[Hypercalcemia (Assessment and Plan)|Hypercalcemia]]

NSTEMI

STEMI

Fever and Neutropenia (Assessment and Plan)

2018-10-01T20:38:10Z

William J Gibson: Created page with "Author: William J Gibson MD, PhD <nowiki>#</nowiki> Fever and neutropenia ANC<1000, T>101.4F/38C. In most patients, source is gut translocation. F..."

Author: [[User:William J Gibson|William J Gibson MD, PhD]]

<nowiki>#</nowiki> Fever and neutropenia

ANC<1000, T>101.4F/38C. In most patients, source is gut translocation.

Factors to consider: anticipated duration of neutropenia, prior infections.

Workup sources:consider CT scan for abdominal infection (add metronidazole), pneumonia, skin exam for cellulitis.

Dx:

Blood cultures x2

Tx:

- Cefepime 2g Q8H

- If concern for MRSA (cavitary PNA, cellulitis), add vanc

- If febrile >4 days on cefepime, add micafungin

Assessment and Plan

2018-10-01T20:35:46Z

William J Gibson: Added F+N

Welcome to the Assessment and Plan project page.

== Cardiology: ==
[[Acute Coronary Syndrome (Assessment and Plan)|Acute Coronary Syndrome]]

CHF - [[HFrEF exacerbation (Assessment and Plan)|HFrEF exacerbation]]

[[Pulmonary embolism (Assessment and Plan)|Pulmonary embolism]]

[[Syncope (Assessment and Plan)|Syncope]]

== Hematology: ==
[[Anemia (Assessment and Plan)|Anemia]]

[[Macrocytic anemia (Assessment and Plan)|Macrocytic anemia]]

[[Microcytic anemia (Assessment and Plan)|Microcytic anemia]]

== Oncology: ==
[[Fever and Neutropenia (Assessment and Plan)|Fever and Neutropenia]]

== Pulmonary: ==

== Other ==
[[Lactic acidosis (Assessment and Plan)|Lactic acidosis]]

== Assessment and Plan Project team ==
Project Leader: [[User:William J Gibson|William J Gibson MD, PhD]]

== Pages to add ==
HFpEF exacerbation

Ventricular Assist Device Evaluation (LVAD, BiVAD evaluation)

Cardiac Transplant Evaluation

Tumor lysis syndrome

NSTEMI

STEMI

Lactic acidosis (Assessment and Plan)

2018-09-27T04:22:59Z

William J Gibson: Created page with "Author: William J Gibson MD, PhD <nowiki>#</nowiki> Lactic acidosis Noted to have lactate of XX. Bicarb XX and ABG revealed pH XX. Most likely caus..."

Author: [[User:William J Gibson|William J Gibson MD, PhD]]

<nowiki>#</nowiki> Lactic acidosis

Noted to have lactate of XX. Bicarb XX and ABG revealed pH XX. Most likely cause of elevated lactate is hypoperfusion due to XX, though differential includes both type A and type B etiologies as below.

Differential includes:

Type A (hypoperfusion): septic vs cardiogenic shock

Type B (no hypoperfusion): liver disease, diabetes, malignancy, alcoholism, beta agonists, mitochondrial dysfunction, drugs ( salicylates, NRTI, propofol, linezolid), regional ischemia

D-lactic acidosis (rare): short gut, DKA

Dx:

- Lactate Q6H, ABG, tox screen, LFTs

Tx:

- Treat underlying cause

- IV fluids (eg 1L LR bolus)

- Consider thiamine and riboflavin supplementation

Assessment and Plan

2018-09-27T04:21:53Z

William J Gibson: Added lactic acidosis

Welcome to the Assessment and Plan project page.

== Cardiology: ==
[[Acute Coronary Syndrome (Assessment and Plan)|Acute Coronary Syndrome]]

CHF - [[HFrEF exacerbation (Assessment and Plan)|HFrEF exacerbation]]

[[Pulmonary embolism (Assessment and Plan)|Pulmonary embolism]]

[[Syncope (Assessment and Plan)|Syncope]]

== Hematology: ==
[[Anemia (Assessment and Plan)|Anemia]]

[[Macrocytic anemia (Assessment and Plan)|Macrocytic anemia]]

[[Microcytic anemia (Assessment and Plan)|Microcytic anemia]]

== Oncology: ==

== Pulmonary: ==

== Other ==
[[Lactic acidosis (Assessment and Plan)|Lactic acidosis]]

== Assessment and Plan Project team ==
Project Leader: [[User:William J Gibson|William J Gibson MD, PhD]]

== Pages to add ==
HFpEF exacerbation

Ventricular Assist Device Evaluation (LVAD, BiVAD evaluation)

Cardiac Transplant Evaluation

Tumor lysis syndrome

NSTEMI

STEMI

Macrocytic anemia (Assessment and Plan)

2018-09-26T08:37:51Z

William J Gibson: Initialized page

Author: [[User:William J Gibson|William J Gibson MD, PhD]]

Noted to have HCT of XX and MCV XX.

Dx:

Tx:

-

References:
#

Assessment and Plan

2018-08-12T18:17:09Z

William J Gibson: Added anemia links

Welcome to the Assessment and Plan project page.

== Cardiology: ==
[[Acute Coronary Syndrome (Assessment and Plan)|Acute Coronary Syndrome]]

CHF - [[HFrEF exacerbation (Assessment and Plan)|HFrEF exacerbation]]

[[Pulmonary embolism (Assessment and Plan)|Pulmonary embolism]]

[[Syncope (Assessment and Plan)|Syncope]]

== Hematology: ==
[[Anemia (Assessment and Plan)|Anemia]]

[[Macrocytic anemia (Assessment and Plan)|Macrocytic anemia]]

[[Microcytic anemia (Assessment and Plan)|Microcytic anemia]]

== Oncology: ==

== Pulmonary: ==

== Assessment and Plan Project team ==
Project Leader: [[User:William J Gibson|William J Gibson MD, PhD]]

== Pages to add ==
HFpEF exacerbation

Ventricular Assist Device Evaluation (LVAD, BiVAD evaluation)

Cardiac Transplant Evaluation

Tumor lysis syndrome

NSTEMI

STEMI

Assessment and Plan

2018-08-11T03:15:46Z

William J Gibson: Added syncope to cardiology section

Welcome to the Assessment and Plan project page.

== Cardiology: ==
[[Acute Coronary Syndrome (Assessment and Plan)|Acute Coronary Syndrome]]

CHF - [[HFrEF exacerbation (Assessment and Plan)|HFrEF exacerbation]]

[[Pulmonary embolism (Assessment and Plan)|Pulmonary embolism]]

[[Syncope (Assessment and Plan)|Syncope]]

== Oncology: ==

== Pulmonary: ==

== Assessment and Plan Project team ==
Project Leader: [[User:William J Gibson|William J Gibson MD, PhD]]

== Pages to add ==
HFpEF exacerbation

Ventricular Assist Device Evaluation (LVAD, BiVAD evaluation)

Cardiac Transplant Evaluation

Tumor lysis syndrome

NSTEMI

STEMI

Syncope (Assessment and Plan)

2018-08-11T02:49:50Z

William J Gibson:

<nowiki>#</nowiki>Syncope

Patient presents after (witnessed/unwitnessed) episode concerning for syncope. There was loss of consciousness. After the event the patient took XX minutes to recover. The patient denies headstrike. The patient reports a prodrome consisting of XX (nausea, diaphoresis, lightheadedness, blurry vision). The patient XX chest pain, palpitations, SOB, numbness, visual changes. Patient also denies incontinence, tongue biting. If no loss of consciousness, but positive prodrome then patient had presyncope. The etiologies of syncope include unknown/idiopathic (36%), neurocardiogenic (21%), orthostasis (9%), cardiogenic (10%), stroke/TIA (4%), seizure (5%), and other miscellaneous (micturition, cough, situational; [https://www.nejm.org/doi/pdf/10.1056/NEJMoa012407 NEJM 2002]).

San Francisco Syncope Rule to Predict Serious Outcomes (<nowiki>http://www.mdcalc.com/san-francisco-syncope-rule-to-predict-serious-outcomes/</nowiki>)

- All cases: telemetry, orthostatic vital signs, CBC, head CT if concern for head strike

- Suspect cardiac (mechanical): D-dimer / CT-PE if hypoxic (PE in 17% hosp pt with syncope [https://www.nejm.org/doi/full/10.1056/NEJMoa1602172 NEJM 2017]), trop, TEE, TTE only if murmur or known structural disease (<1% abnl w/o hx heart dz) ; (electrical) Discharge with rhythm monitor

- Suspect neurocardiogenic: Reassurance + avoidance of provocative stimuli, educate patient on isometric counterpressure maneuvers (eg leg cross, hand grip). Several negative trials for Rx intervention (Fludrocort ([https://www.ncbi.nlm.nih.gov/pubmed/16781217 POST-II]), metoprolol ([https://www.ncbi.nlm.nih.gov/pubmed/16505178 POST]), PPM ([https://www.ncbi.nlm.nih.gov/pubmed/12734133 VPS-II]), tilt test no longer recommended.

- Suspect orthostatic: re-evaluate beta-blockers, diuretics, antihypertensives, consider midodrine [5-10mg] if history highly consistent with orthostatic hypotension (or repeated episodes).

- Suspect neurologic/seizure: Complete neuro exam, EEG

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Differential for syncope is broad (included separately from A/P for brevity):

Neurocardiogenic: Carotid sinus cardioinhibitory, Vasovagal cough, Micturition/defecation, Post-prandial valsalva, Sneeze

Orthostatic: Iatrogenic (Diuretic drugs, Anti-hypertensives), Dehydration, Blood Loss, Autonomic insufficiency, Adrenal Insufficiency, Idiopathic

Cardiac (mechanical): AS, PS, HOCM, Myxoma, PE, Aortic dissection, MI

Cardiac (electrical): AV Block, Sick Sinus Syndrome, (NS)VT, Long QT syndrome, Bradycardia, Ischemia, Pre-Excitation/WPW, ARVD (look for epsilon waves)

Neurologic: Seizure, TIA, Stroke (cerebellar), Subclavian steal syndrome, Vertebrobasilar insufficiency

Psychogenic: Conversion, Panic disorder

Syncope (Assessment and Plan)

2018-08-11T02:47:08Z

William J Gibson:

<nowiki>#</nowiki>Syncope

Patient presents after (witnessed/unwitnessed) episode concerning for syncope. There was loss of consciousness. After the event the patient took XX minutes to recover. There XXX headstrike. The patient reports a prodrome consisting of XX (nausea, diaphoresis, lightheadedness, blurry vision). The patient XX chest pain, palpitations, SOB, numbness, visual changes. Patient also denies incontinence, tongue biting. If no loss of consciousness, but positive prodrome then patient had presyncope. The etiologies of syncope include unknown (36%), neurocardiogenic (21%), orthostasis (9%), cardiogenic (10%), stroke/TIA (4%), seizure (5%), and other miscellaneous (micturition, cough, situational; [https://www.nejm.org/doi/pdf/10.1056/NEJMoa012407 NEJM 2002]).

San Francisco Syncope Rule to Predict Serious Outcomes (<nowiki>http://www.mdcalc.com/san-francisco-syncope-rule-to-predict-serious-outcomes/</nowiki>)

- All cases: telemetry, orthostatic vital signs, CBC, head CT if concern for head strike

- Suspect cardiac (mechanical): D-dimer / CT-PE if hypoxic (PE in 17% hosp pt with syncope [https://www.nejm.org/doi/full/10.1056/NEJMoa1602172 NEJM 2017]), trop, TEE, TTE only if murmur or known structural disease (<1% abnl w/o hx heart dz) ; (electrical) Discharge with rhythm monitor

- Suspect neurocardiogenic: Reassurance + avoidance of provocative stimuli, educate patient on isometric counterpressure maneuvers (eg leg cross, hand grip). Several negative trials for Rx intervention (Fludrocort ([https://www.ncbi.nlm.nih.gov/pubmed/16781217 POST-II]), metoprolol ([https://www.ncbi.nlm.nih.gov/pubmed/16505178 POST]), PPM ([https://www.ncbi.nlm.nih.gov/pubmed/12734133 VPS-II]), tilt test no longer recommended.

- Suspect orthostatic: re-evaluate beta-blockers, diuretics, antihypertensives, consider midodrine [5-10mg] if history highly consistent with orthostatic hypotension (or repeated episodes).

- Suspect neurologic/seizure: Complete neuro exam, EEG

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Differential for syncope is broad (included separately from A/P for brevity):

Neurocardiogenic: Carotid sinus cardioinhibitory, Vasovagal cough, Micturition/defecation, Post-prandial valsalva, Sneeze

Orthostatic: Iatrogenic (Diuretic drugs, Anti-hypertensives), Dehydration, Blood Loss, Autonomic insufficiency, Adrenal Insufficiency, Idiopathic

Cardiac (mechanical): AS, PS, HOCM, Myxoma, PE, Aortic dissection, MI

Cardiac (electrical): AV Block, Sick Sinus Syndrome, (NS)VT, Long QT syndrome, Bradycardia, Ischemia, Pre-Excitation/WPW, ARVD (look for epsilon waves)

Neurologic: Seizure, TIA, Stroke (cerebellar), Subclavian steal syndrome, Vertebrobasilar insufficiency

Psychogenic: Conversion, Panic disorder

Syncope (Assessment and Plan)

2018-08-11T02:46:07Z

William J Gibson:

<nowiki>#</nowiki>Syncope

Patient presents after (witnessed/unwitnessed) episode concerning for syncope. There was loss of consciousness. After the event the patient took XX minutes to recover. There XXX headstrike. The patient reports a prodrome consisting of XX (nausea, diaphoresis, lightheadedness, blurry vision). The patient XX chest pain, palpitations, SOB, numbness, visual changes. Patient also denies incontinence, tongue biting. If no loss of consciousness, but positive prodrome then patient had presyncope. The etiologies of syncope include unknown (36%), neurocardiogenic (21%), orthostasis (9%), cardiogenic (10%), stroke/TIA (4%), seizure (5%), and other miscellaneous (micturition, cough, situational; [https://www.nejm.org/doi/pdf/10.1056/NEJMoa012407 NEJM 2002]).

San Francisco Syncope Rule to Predict Serious Outcomes (<nowiki>http://www.mdcalc.com/san-francisco-syncope-rule-to-predict-serious-outcomes/</nowiki>)

- All cases: telemetry, orthostatic vital signs, CBC, head CT if concern for head strike

- Suspect cardiac (mechanical): D-dimer / CT-PE if hypoxic (PE in 17% hosp pt with syncope [https://www.nejm.org/doi/full/10.1056/NEJMoa1602172 NEJM 2017]), trop, TEE, TTE only if murmur or known structural disease (<1% abnl w/o hx heart dz) ; (electrical) Discharge with rhythm monitor

- Suspect neurocardiogenic: Reassurance + avoidance of provocative stimuli, educate patient on isometric counterpressure maneuvers (eg leg cross, hand grip). Several negative trials for Rx intervention (Fludrocort ([https://www.ncbi.nlm.nih.gov/pubmed/16781217 POST-II]), metoprolol ([https://www.ncbi.nlm.nih.gov/pubmed/16505178 POST]), PPM ([https://www.ncbi.nlm.nih.gov/pubmed/12734133 VPS-II]), tilt test no longer recommended.

- Suspect orthostatic: re-evaluate beta-blockers, diuretics, antihypertensives, consider midodrine [5-10mg] if history highly consistent with orthostatic hypotension (or repeated episodes).

- Suspect neurologic/seizure: Complete neuro exam, EEG

Differential for syncope is broad (included separately from A/P for brevity):

Neurocardiogenic: Carotid sinus cardioinhibitory, Vasovagal cough, Micturition/defecation, Post-prandial valsalva, Sneeze

Orthostatic: Iatrogenic (Diuretic drugs, Anti-hypertensives), Dehydration, Blood Loss, Autonomic insufficiency, Adrenal Insufficiency, Idiopathic

Cardiac (mechanical): AS, PS, HOCM, Myxoma, PE, Aortic dissection, MI

Cardiac (electrical): AV Block, Sick Sinus Syndrome, (NS)VT, Long QT syndrome, Bradycardia, Ischemia, Pre-Excitation/WPW, ARVD (look for epsilon waves)

Neurologic: Seizure, TIA, Stroke (cerebellar), Subclavian steal syndrome, Vertebrobasilar insufficiency

Psychogenic: Conversion, Panic disorder

Syncope (Assessment and Plan)

2018-08-11T02:31:48Z

William J Gibson:

<nowiki>#</nowiki>Syncope

Patient presents after (witnessed/unwitnessed) episode concerning for syncope. There was loss of consciousness. After the event the patient took XX minutes to recover. There XXX headstrike. The patient reports a prodrome consisting of XX (nausea, diaphoresis, lightheadedness, blurry vision). The patient XX chest pain, palpitations, SOB, numbness, visual changes. Patient also denies incontinence, tongue biting. If no loss of consciousness, but positive prodrome then patient had presyncope. The etiologies of syncope include unknown (36%), neurocardiogenic (21%), orthostasis (9%), cardiogenic (10%), stroke/TIA (4%), seizure (5%), and other miscellaneous (micturition, cough, situational; [https://www.nejm.org/doi/pdf/10.1056/NEJMoa012407 NEJM 2002]).

San Francisco Syncope Rule to Predict Serious Outcomes (<nowiki>http://www.mdcalc.com/san-francisco-syncope-rule-to-predict-serious-outcomes/</nowiki>)

- All cases: telemetry, orthostatic vital signs, CBC, head CT if concern for head strike

- Suspect cardiac (mechanical): D-dimer / CT-PE if hypoxic (PE in 17% hosp pt with syncope [https://www.nejm.org/doi/full/10.1056/NEJMoa1602172 NEJM 2017]), trop, TEE, TTE only if murmur or known structural disease (<1% abnl w/o hx heart dz) ; (electrical) Discharge with rhythm monitor

- Suspect neurocardiogenic: Reassurance + avoidance of provocative stimuli, educate patient on isometric counterpressure maneuvers (eg leg cross, hand grip). Several negative trials for Rx intervention (Fludrocort ([https://www.ncbi.nlm.nih.gov/pubmed/16781217 POST-II]), metoprolol ([https://www.ncbi.nlm.nih.gov/pubmed/16505178 POST]), PPM ([https://www.ncbi.nlm.nih.gov/pubmed/12734133 VPS-II]), tilt test no longer recommended.

- Suspect orthostatic: re-evaluate beta-blockers, diuretics, antihypertensives, consider midodrine [5-10mg] if history highly consistent with orthostatic hypotension (or repeated episodes).

- Suspect neurologic/seizure: Complete neuro exam, EEG

Syncope (Assessment and Plan)

2018-08-10T23:17:14Z

William J Gibson: Added some stats

Assessment and Plan

2018-08-10T21:06:25Z

William J Gibson: Added syncope

Acute Coronary Syndrome (Assessment and Plan)

2018-07-08T15:25:16Z

William J Gibson: added myocarditis to differential and caution regarding inferior MI

Author: [[User:William J Gibson|William J Gibson MD, PhD]]

Patient presents with XX hour history of [substernal] chest pain that radiates to [jaw/arm], associated with [diaphoresis, shortness of breath]. EKG on admission showing XX. Troponin on admission XX and subsequently trended to XX XX hours later. [Most likely type 1 MI given abrupt onset, ST-segment elevation OR History suggests type 2 MI given high concern for supply-demand mismatch. Differential includes coronary dynamic/non-occlusive obstruction (including vasospasm, microvascular ischemia, Takutsubo cardiomyopathy, myocarditis), non-plaque associated thromboembolism (Afib, cardioversion, PFO), coronary dissection, vascular steal, vasculitis.

Dx:

- Serial EKG (Q30 mins initially), if STEMI

- Serial troponins (admission, 2H and 6H) if concern ACS rapidly evolving, 3x Q6H for rule-out (if 5th generation hsTn: Serial troponins Q3H sufficient)

Risk stratification:

- TIMI Risk Score (NSTEMI): https://www.mdcalc.com/timi-risk-score-ua-nstemi

- If GRACE Score > 140, early invasive strategy may be preferred (cath <72h [1]) http://www.outcomes.org/grace

- HbA1c, lipid panel

- Consider further risk stratification (stress test vs CT angio vs coronary angiography)

- TTE to rule out new wall motion abnormality

Tx:

- Treat any secondary causes of myocardial ischemia (eg AF w RVR, anemia, hypoxemia (only if O2sat <92%), infection)

Initial therapy:

- Anticoagulation/Anti-platelet: ASA (325), Heparin drip (goal PTTT 60-80), defer clopidogrel on admission given unclear if patient will need CABG

- Rate: Metoprolol 25mg PO Q6H, titrate to HR 50-60 (will hold if evidence of shock, AV-block)

- Pain: sublingual nitro PRN (caution if inferior MI), defer morphine given interference with P2Y12 inhibitors and retrospective analyses suggesting increased adverse events.

- Defer oxygen given randomized evidence of increased infarct size in STEMI without hypoxia [2]

- Lipids: Atorvastatin 80mg [3]

Long term: Plan for ASA 81mg QD, P2Y12 (preference: ticagrelor>prasugrel>clopidogrel), Beta blocker, Statin, ACE (esp if EF<40%)/ARB, consider spironolactone (RALES), ezetimibe (IMPROVE-IT), low-dose rivaroxaban (ATLAS-2), empagliflozin if DM (EMPA-REG).

Post-stenting:

- if stented will give clopidogrel 75mg PO QD (30 days of BMS, 1 year for DES)

References:
# Mehta SR, Granger CB, Boden WE, et al. Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med. 2009;360(21):2165-75.
# Stub D, Smith K, Bernard S, et al. Air Versus Oxygen in ST-Segment-Elevation Myocardial Infarction. Circulation. 2015;131(24):2143-50.
# Cannon CP, Braunwald E, Mccabe CH, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004;350(15):1495-504.

Assessment and Plan

2018-07-02T04:43:42Z

William J Gibson: /* Cardiology: */ Added pulmonary embolism

Pulmonary embolism (Assessment and Plan)

2018-07-02T04:43:20Z

William J Gibson: Created template

Author: [[User:William J Gibson|William J Gibson MD, PhD]]

Patient presents with

Dx:

Tx:

-

References:

Acute Coronary Syndrome (Assessment and Plan)

2018-06-30T01:24:42Z

William J Gibson:

Author: [[User:William J Gibson|William J Gibson MD, PhD]]

Patient presents with XX hour history of [substernal] chest pain that radiates to [jaw/arm], associated with [diaphoresis, shortness of breath]. EKG on admission showing XX. Troponin on admission XX and subsequently trended to XX XX hours later. [Most likely type 1 MI given abrupt onset, ST-segment elevation OR History suggests type 2 MI given high concern for supply-demand mismatch. Differential includes coronary dynamic/non-occlusive obstruction (including vasospasm, microvascular ischemia, Takutsubo cardiomyopathy), non-plaque associated thromboembolism (Afib, cardioversion, PFO), coronary dissection, vascular steal, vasculitis.

Dx:

- Serial EKG (Q30 mins initially), if STEMI

- Serial troponins (admission, 2H and 6H) if concern ACS rapidly evolving, 3x Q6H for rule-out (if 5th generation hsTn: Serial troponins Q3H sufficient)

Risk stratification:

- TIMI Risk Score (NSTEMI): https://www.mdcalc.com/timi-risk-score-ua-nstemi

- If GRACE Score > 140, early invasive strategy may be preferred (cath <72h [1]) http://www.outcomes.org/grace

- HbA1c, lipid panel

- Consider further risk stratification (stress test vs CT angio vs coronary angiography)

- TTE to rule out new wall motion abnormality

Tx:

- Treat any secondary causes of myocardial ischemia (eg AF w RVR, anemia, hypoxemia (only if O2sat <92%), infection)

Initial therapy:

- Anticoagulation/Anti-platelet: ASA (325), Heparin drip (goal PTTT 60-80), defer clopidogrel on admission given unclear if patient will need CABG

- Rate: Metoprolol 25mg PO Q6H, titrate to HR 50-60 (will hold if evidence of shock, AV-block)

- Pain: sublingual nitro PRN, defer morphine given interference with P2Y12 inhibitors and retrospective analyses suggesting increased adverse events.

- Defer oxygen given randomized evidence of increased infarct size in STEMI without hypoxia [2]

- Lipids: Atorvastatin 80mg [3]

Long term: Plan for ASA 81mg QD, P2Y12 (preference: ticagrelor>prasugrel>clopidogrel), Beta blocker, Statin, ACE (esp if EF<40%)/ARB, consider spironolactone (RALES), ezetimibe (IMPROVE-IT), low-dose rivaroxaban (ATLAS-2), empagliflozin if DM (EMPA-REG).

Post-stenting:

- if stented will give clopidogrel 75mg PO QD (30 days of BMS, 1 year for DES)

References:
# Mehta SR, Granger CB, Boden WE, et al. Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med. 2009;360(21):2165-75.
# Stub D, Smith K, Bernard S, et al. Air Versus Oxygen in ST-Segment-Elevation Myocardial Infarction. Circulation. 2015;131(24):2143-50.
# Cannon CP, Braunwald E, Mccabe CH, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004;350(15):1495-504.

Acute Coronary Syndrome (Assessment and Plan)

2018-06-29T23:01:44Z

William J Gibson:

Board Review

2018-05-21T15:09:53Z

William J Gibson:

Widget:Board Review Stable v0.4

2018-05-21T15:07:33Z

William J Gibson:

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