More Questions Flashcards
Management of ER +, PR +, HER-2 negative breast cancer w/ low risk of recurrence
Radiation + Tamoxifen
Tx for patients w/ advanced ovarian cancer after optimal treatment and surgical resection
IV and Intraperitoneal cisplatin and paclitaxel
Patients w/ increased breast density
At increased risk for breast cancer (20-25%), HOWEVER, normal cancer monitoring is recommended
If other coexisting risk factors are present, then patients need breast MRI
Diffuse idiopathic skeletal hyperostosis
Flowing, linear calcifications and ossifications on the anterolateral aspects of the vertebral bodies
Typically see upward pointing spurs in the lumbar spine; downward in cervical
Relapsing, remitting HAV
Pt who develops HAV symptoms again 3 months after infection resolved
Typically milder, but can be assoc. w/ nephritis, arthralgia, vasculitis, and cryoglobulinemia
Consideration prior to starting allopurinol
HLA-B 5801 allele which can cause DRESS
Pts to screen include Thai, Chinese, Korean, and CKD pts
Test for Alzheimer’s in pts w/ MCI
LP; shows decreased AB42 peptide and increased tau protein
> 80% sensitivity and specificity
Other EKG findings of hypercalcemia
PR prolongation
Increased QRS amplitude
T wave upslope
Skin changes of amyloidosis
Pinch purpura (bruising w/ slight pressure). ecchymoses around eyes (raccoon eyes), yellow, waxy pearls in periorbital area
Indications for AV replacement w/ SEVERE regurgitation
Symptomatic
LVEF <50%
LV dilation
If absent, then just repeat echo q6-12months
Tx of MSSA osteomyelitis w/ infected hardward
Penicillin + Rifampin
-Helps to eradicate potential biofilms formed on the hardware
Amyopathci dermatomyositis
Experience heliotrope rash, Gottron papules, shawl sign, but w/o clinical or lab evidence of muscle disease
-Pts still at increased risk of malignancy and pulmonary fibrosis
Shawl sign
Widespread, flat, and red area on the upper back and shoulders associated w/ dermatomyositis
Respiratory-bronchiolitis associated ILD
Imaging in smokers reveal centrilobular micronodules w/ tan-pigmented macrophages on biopsy
-Pts often asymptomatic and in 4-5th decade of smoking
Pts w/ afib and HOCM
Needs anticoagulation
Microscopic colitis
Typically presents in the setting of months of chronic, watery diarrhea unresponsive to medical therapy
Tx: Stop offending meds, loperamide, budesonide last line but very effective
Primary angiitis of the CNS
Presents w/ gradual, progressive neurologic sx like HA, cognitive deficits, and other unusual focal findings
Labs: Unremarkable but LP shows lympocytic pleocytosis and increased protein
Cerebral angiogram CAN MAYBE show beading
Brain bx shows granulomatous vasculitis but only has 50% sensitivity
Tx: High dose glucocorticoids + cyclophosphamide for 3-6months followed by azathioprine maintenance therapy
Indications for kidney biopsy
Glomerular hematuria
Severely increased albuminuria
Acute or Chronic Kidney Disease of unclear cause
Kidney transplant dysfnxn or monitoring
Myoclonic seizure
Consists of one, single jerk of the entire body lasting approx 1 sec; pts retain awareness and have no post-ictal confusions
Tx of hypertensive emergency
Lower BP by no more than 25% in first hour; lower SBP to 160 within 6 hrs
Tx for gouty cellulitis
Prednisone
Adrenal mass indicators of malignancy
> 4cm
Density >10 Houndsfield units
Absolute contrast washout <50% after 10 mins
Labs to monitor in hypoparathyroidism
Calcium
Mg
Cr
Urine calcium-many patients will have low levels
First step in management of prepatellar bursitis
ASPIRATE
Management of tricuspid regurgitation
TTE first
STD screening in homosexuals
Require annual HIV, syphilis, gonorrhea, and chlamydia screening
Osborn wave
EKG finding in hypothermia; looks like a second QRS immediately after the first one
Medication to start within 24 hours of an MI-related case of acute CHF
ACEI or ARB
Cyclic mastalgia
Bilateral, diffuse breast pain that worsens during menses then abates
First line tx= Well fitting bra
Treatment of post-MI Mobitz Type II HB
Temporary pacing
Stage I Pulmonary Sarcoidosis
Bilateral hilar lymphadenopathy with no other symptoms or disruption of pulmonary architecture
Management = Observation
May need to check Ca, EKG, and eye exam
Red Flags for Secondary Headache
Age > 50 Use of anticoagulant Progressive pattern Abrupt onset/thunderclap Association w/ neurologic symptoms lasting >1hr Alterations in consciousness Abnormal physical exam Onset after exertion or sex
=>Presence of these factors warrants Brain MRI
1st Line Prevention therapy for Tension-Type Headache
Amitriptyline
Nutritional management of acute necrotic pancreatitis
Initiate enteral tube feeding ASAP; helps to maintain healthy mucosal GI barrier
“Mechanic’s Hands”
Hyperkeratotic and fissured skin on the lateral sides and tips of the fingers (extra dry skin); associated w/ dermatomyositis, polymyositis…particularly associated w/ antisynthetase syndrome
Patient’s at higher risk of developing hypocalcemia and symptoms on bisphosphonate therapy
Vitamin D deficient patients
Hungry Bone Syndrome
Occurs following parathyroidectomy; following loss of PTH, rapid influx of Ca into bone from the bloodstream
Morphea
Localized form of scleroderma limited to one or two indurated, thickened plaques on the extremities or around the waistline
Screening for HCV patients w/ evidence of cirrhosis
RUQ US q6months; evaluate for development of hepatocellular carcinoma
*This is done REGARDLESS of their response to HCV treatment
Defining MS
Clinical relapses or MRI changes = Activity
Gradual accumulation of deficits = Progression
First line tx for Ankylosing Spondylitis
DAILY NSAIDs
Goal UOP w/ hypercalciuria to prevent stones
2.5-3L/day
Indications for surgery w/ SEVERE aortic regurg
Symptoms attributable to this or EF < 50%
Treatment of HBV in pregnancy to prevent vertical transmission
Tenofovir
Treatment for adrenal insufficiency
Hydrocortisone twice daily + fludrocortisone once daily
Antiplatelet therapy for patient’s treated w/ conservative management after MI
ASA + Ticagrelor for one year
-Shown to be superior to Plavix in prevent CV death, MI, and CVA
Most likely culprit of Infection Related Glomerulonephritis in first world countries
Staph aureus
Treatment for impaired mobility w/ MS
Dalfampridine; voltage gated K+ channel antagonist
Theoretically promotes conductance along the axons of long motor neurons
Studies have showed significant improvements in timed walking tests
ADR: Increases seizure potential; do not use w/ renal dysfnxn
Management of pressure ulcers
Hydrocolloid or foam dressings
Protein supplementation
Electrical stimulation
Screening study for cirrhotic patients
DEXA scan
Patient’s are known to be at higher risk for developing osteoporosis; all patient’s should be evaluated w/ baseline scan
First step in management of CNS lymphoma
Intravitreous sampling
HOLD GLUCOCORTICOIDS; they are lymphotoxic and will lead to false negative serology
ONLY GIVE W/ SIGNS of BRAINSTEM COMPRESSION
Treatment for persistent Crohn’s Disease
Anti-TNF agents
Evaluation for recurrent epistaxis
Nasal endoscopy
Medication to add w/ CHF patients w/ EF <40% and history of STEMI
Aldosterone antagonist
Treatment of behavioral variant FTD
SSRIs; TCAs
Pseudostenosis
Patient w/ EF <35% who appears to have severe aortic stenosis; appears the valve doesn’t open due to decreased cardiac contractility and SV
Differentiate b/w true aortic stenosis w/ dobutamine echocardiography
Chest CT in rheumatoid patient
May have subpleural or intraseptal nodules
AI Pancreatitis lab
IgG4
When to initiate dialysis
Either when GFR <7 or when uremic symptoms appear
This data is based off the IDEAL study in 2010
Treating a relapse of polymyaglia rheumatica
Increase prednisone to the lowest effective dose previously then taper by 1mg every 4 weeks
First line agents for MS treatment
IFN-B or Glatiramir acetate
***Give glatiramir w/ any compromise in hepatic function
Therapy for MS when 1st line therapy has failed
Natilizumab
Iron levels to maintain as suggested by KDIGO in CKD
Transferrin saturation > 30%
Ferritin >500
If Stage 5 CKD, likely needs IV iron
Milan Criteria
Criteria for liver transplant w/ hepatocellular carcinoma
3 tumors <3cm or one tumor <5cm; excellent fiver year survival rate if treated w/ transplant
First medication to give with myxedema coma
Hydrocortisone
If you give thyroid hormone first, you could precipitate an adrenal crisis; make sure to check cortisol on EVERY PATIENT WITH MYXEDEMA COMA
Most common form of syncope in young people
Neurocardiogenic syncope; typically occurs after stimulus of fear, noxious stimuli, stress, heat exposure, situational w/ coughing, micturition
Can also occur w/ carotid sinus hypersensitivity in people wearing tight collars
Prodromal symptoms are usually absent
Sudden sensorineural hearing loss
Associated w/ fullness, tinnitus, and a Weber’s test that lateralizes to the opposite ear
Requires urgent otolaryngologist work up
Treat w/ high dose steroids although the effectiveness of this is questionable
Treatment for ESRD lupus nephritis
Mycophenolate mofetil
Treatment of kidney stone w/ hypercalciuria
Thiazides
MS patient on maximum therapy who is still developing new lesions
Measure Vitamin D level; deficiencies associated w/ disease progression
Bone infarct
Osteonecrosis of the metaphysis/diaphysis of a bone; appears to show patchy lucencies and necrosis w/ occasional collapse of the bone
If occurring at the epiphysis, you call it avascular necrosis
Morphea
Limited scleroderma to one of two patches to the torso or proximal extremities
Lacks the visual manifestations and Raynaud’s of systemic sclerosis
Patient w/ peripheral neuropathy on therapy who begins developing peripheral edema
Likely due to pregabalin; is a CCB, therefore, produces edema via that mechanism
Chronic Lead Nephropathy
Occurs in pts w/ occupational exposure, lead in water, soil, plant, or food or distilled alcohol
-Lead-containing car radiators condense the alcohol
Associated w/ HTN, hyperuricemia, and gout attacks
Pt w/ abdominal fullness and neurologic signs like choreoathetosis, pysch stuff, seizures
NMDA encephalitis 2/2 ovarian teratoma
50% of pts w/ ovarian teratoma will have positive antibodies
What to do when echo findings of are in-congruent w/ physical exam findings?
Cardiac catheterization; needs evaluation prior to consideration for TAVR
Sudden rise in Cr after initiating ACEI in a young hypertensive pt
Consider RAS
Tx for HBV in pregnant patient
Tenofovir; could also use lamivudine, however, it is a category C medication in pregnant patients
Use if HBV level >200,000 IU/mL at 24-28weeks
Monitoring for patient’s w/ secondary hypothyroidism
Must monitor free T4; want to keep in the upper halfo of the normal range
Take Levothyroxine on an empty stomach, 1-3 hours before ingestion of food
Calcium and iron supplements will interfere w/ absorption; avoid taking 3 hours prior to taking levothyroxine
HCV testing to obtain prior to discharging patient’s in order for them to get f/up w/ Carr
Viral load
Antibody testing
UDS
Fibrometer testing
Medication to start on patient w/ maximum dosing of COPD meds and still having recurrent exacerbations
Roflumilast; CI’d w/ liver disease; may cause insomnia, depression
Management of BP in long term after hemorrhagic CVA
<130/<80; best data surrounds starting an ACEI
Treatment of dermatitis herpetiformis
Dapsone
Remember, still need gluten free diet as well as pt likely has celiac disease
Causes of NONANION gap metabolic acidosis
Carbonic anhydrase RTA Urostomy Diarrhea Expansion w/ NS
Patient w/ minimal protein on dipstick but greatly elevated Urine Protein-Cr ratio
Have to consider MM as cause of renal dysfnxn
Pyroglutamic acidosis
Patients w/ anion gap metabolic acidosis and AMS who take acetaminophen on a chronic basis.
Pts w/ decreased nutrition, CKD, liver disease, vegetarian diet
Ranexa benefits
Decreases chest pain and decreases risk for afib
Drug cause of reversible hearing loss
Zithromax
Treatment of cryoglobulinemia
Just treat the hep c
Meltzer triad
Combination of asthenia, arthralgia, and palpable purpura in a patient with Hep C compatible with cryoglobulinemia
Management of ER + ductal carcinoma in situ
Anastrazole
Treatment of dermatitis herpetiformis
Gluten free diet + DAPSONE
Treatment of behavioral manifestations of FTD
Citalopram
Test to order to evaluate for cardiac ischemia w/ baseline LVH and repolarization abnormalities
Coronary CTA
PROMISE TRIAL: Compared coronary CTA with exercise angiography and had no differences in 2 year outcomes that included death, MI, hospitalizations for unstable angina)
Reversible cerebral vasoconstriction syndrome
“Thunderclap” headache that reaches its worst within 5 mins; typically occurs multiple times
Normal head imaging distinguishes from SAH
Dx: MRA/Head CTA
Triggers: SSRIs, sympathomimetic agents, exertion, shower, valsava, emotion
Tx: CCBs
How often to screen older patients for glaucoma
Every 1-2 years
FRAIL Score
Fatigue: Feeling this way most of the time for 4 weeks
Resistance: Difficulty walking up 10 steps
Ambulation: Can’t walk 100 yards without difficulty
Illness: 5 or more medical comorbidities
Loss of weight: >5% weight loss in one year
Service that covers ADLs for at frail at home patients if needed
Medicaid
Medicare DOES NOT
Rehab facility requirement
Must be able to participate in 3 hours of physical therapy 5 days/week
Medicare/Medicaid will pay for up to 100 days of this just like with nursing home
Surgery to perform in myxomatous mitral valve degeneration
Mitral valve repair; associated w/ better overall mortality outcomes
Indications:
- Symptomatic patient w/ EF > 30%
- Asymptomatic patient w/ EF 30-60% and/or LV end systolic diameter > 40mm
- Patients undergoing another cardiac procedure
- PAH (PA pressure >50)
- New onset afib
Winter’s Formula
1.5 x [HCO3] + 8 +/- 2
Checks for appropriate response to metabolic acidosis
Medication for patient w/ newly discovered, symptomatic brain metastasis
Glucocorticoids
Should be tapered to lowest tolerated dose following radiosurgery
Atopic dermatitis classic areas of involvement
Antecubital and popliteal fossae and flexural wrists
Ranolazine and diltiazem
Must decrease ranolazine by 50% if starting nondihydropyridine CCB due to CYP inhibition; additionally, ranolazine will affect the Na-dependent Ca2+ channels in the myocardium
Patient with leukemia and a high potassium
Pseudohyperkalemia; due to elevated WBC
Check plasma potassium
Substitute for cisplatin in patients w/ poorly differentiated SCC and have CKD
Cetuximab
Contraindication for adenosine in patient’s with COPD who need cardiac eval
Adenosine causes bronchospasm
Pruritic urticarial papules and plaques of pregnancy
Self limiting condition that arises in the third trimester; can be treated w/ topical glucocorticoids
Pseudobulbar affect
Neurologic disorder characterized by involuntary outbursts of laughing/crying out of proportion to event
Sometimes associated w/ vascular cognitive dementia; may get improvement w/ donepezil
Outpatient management of PE
NOAC therapy is equivalent to LMWH
Labs for COVID-19
CBC, BMP, Mg, LFT, CRP, procal, CPK, trop, d dimer, PTT, INR, proBNP
Repeat w/ clinical worsening
Considerations for worsening pulm status w/ COVID
Proning
Inhaled epoprostenol, NO
Lab markers of worse disease w/ COVID-19
Lymphopenia Elevated troponin LDH D-dimer CRP
Figure 3 sign
Sign of aortic correction where the aorta dilates and then narrows on CXR giving the aorta and mediastinal area an appearance of a “3”
Anticoagulation w/ mechanical aortic valve
Warfarin AND ASA
Cardiac syndrome
Young woman who presents w/ symptoms of classic angina but normal workup
Kinda like fibromyalgia but cardiac version
Infection related glomerulonephritis
Mostly caused by S. aureus in America
Associated w/ low complement and IgA, elevated urine protein-creatinine ratio, and proliferative glomerulonephritis on biopsy w/ subepithelial hump deposits
Treatment for microscopic colitis
Budesonide
Lab to order if you want to r/out Strep infection
ASO
Meds you can order for hiccup
Gabapentin
Thorazine
Baclofen
Intracranial Hypotension
Noted by orthostatic headache that improves after laying down; may have falsely localizing exam w/ CN VI palsy
Tx: Epidural blood patch; examine for CSF loss
Maintenance chemo for patients who have received 6 cycles of cisplatin + pemetrexed therapy for non small cell pulmonary adenocarcinoma
Pemetrexed maintenance chemotherapy
Way to check if hypokalemia is due to renal losses
Spot Urine K+ : Cr ratio
> 13 indicates renal losses
Consider Falconi syndrome, Vitamin D deficiency in these cases
21-Gene recurrence score for breast cancer
If <10%, patient’s w/ ER +, Progesterone + cancer just need tamoxifen
If > 10, also need adjuvant chemo
AMPLE quick assessment
Allergies Medications Past Medical History Last meal Recent events
Treatment of carabapenemase producing Klebsiella
Colistin, tigecycline, ceftazidime-avibactam
Electrolyte abnormality associated w/ high respiratory failure mortality
Hypophosphatemia; repletion associated w/ better outcomes
Living will
ONLY GOES INTO EFFECT AFTER PATIENT IS IN A VEGETATIVE STATE
THEY CAN BE FULL CODE PRIOR TO THIS
When to start chemical thromboprophylaxis in hemorrhagic CVA patient
With 48 hours of no continued bleeding evidence on MRI
Lab to measure in management of hypoparathyroidism
Urine calcium; want to limit long term hypercalciuria
Calcineurin-inhibitor induced HTN
Caused by upregulation of the NaCl channels in the DCT
Treat w/ thiazides
Papillary fibroelastoma
Small lesion on a myocardial valve usually associated w/ a stalk
Tx: Surgery if symptomatic; controversial if asymptomatic
Treatment for cryptococcal meningitis
Liposomal amphotericin B + Flucytosine
Medication to add for diuresis when loop diuretics fail in nephrotic syndrome
Thiazide diuretics
Preferred treatment for methemeglobinemia
Methylene blue; indicated for methemeglobin levels >20% and works by causing NAD+ to convert Fe3+ (shifts Hgb-dissoctaion curve to left) to Fe2+, the natural state of Hgb within the RBC
Causes of methemeglobinemia
Dapsone, Reglan, antimalarials, and topical anesthetics
- Risk is intensified in patients w/ G6PD deficiency
- Check w/ Masmo oximeter
Erythromelalgia
Pain, numbness, and burning in the feet/hands associated w/ erthrocytosis
Indications for parathyroidectomy in hyperparathyroidism
- Calcium level >1 above normal
- CrCl <60
- 24hr urine calcium >400mg/day
- Presence of nephrolithiasis on imaging
- T score < -2.5
- Age <50
Otherwise, just SERIALLY MONITOR serum calcium, creatinine, and BMD q6months
2nd most common cause of thunderclap headache
Reversible Cerebral Vasoconstriction Syndome
Presents w/ multiple thunderclap headaches over a short period of time; can be brought on by vasoactive substances and SSRIs
Dx/Tx: CTA/MRA; CCBs
Patients who need abx prophylaxis for SBP
Ascitic fluid protein level <1.5 AND (one of these):
- Serum Na <130
- Serum Cr >1.2
- Serum BUN >25
- Serum bilirubin >3
- Child-Turcotte-Pugh Class B or C cirrhosis
- Any previous episode of SBP
Tx; Lifelong Ciprofloxacin
Microvascular angina
Patients w/ typical angina and found to have elevated cardiac biomarkers HOWEVER have normal coronary angiography; patients are typically female and in their 50s
Typically, cardiac MRI will reveal perfusion defects though
Tx: CCBs
When to stop denosumab therapy
Never; it only works as long as it is being administered; DEXA isn’t even recommended while on therapy
Standard therapy for castrate-positve prostate cancer
GnRH agonist + docetaxel
Meds patients who have had bariatric surgery cannot take
NSAIDs
Therapy for most athersclerotic renal disease
ACEI; only in severe cases is there an intervention performed
Periop management of SCD patients
Transfuse to Hgb 10
Ensure Incentive spirometry post op
Hallmark of therapy for IgA nephropathy
ACEI/ARB
Obviously, with more progressive disease, will need more severe interventions but these meds are proven to slow progression
Treatment of chronic HBV that is in the immune reactive phase
Tenofovir
Required overlap for warfarin bridging
5 days with at least two documented therapeutic INRs
Telogen effluvium
Most common cause of diffuse alopecia in women that occurs commonly after pregnancy (can occur after any physiologically stressing event as well)
Generalized, nonscarring alopecia that presents as excessive shedding
Typically resolves spontaneously in 6-12 months
a-blocking agent to start before removal of pheochromocytoma
Phenoxybenzaprine
What to do with heparin after cardiac cath
STOP IT UNLESS OTHERWISE INSTRUCTED
Complication when you anticoagulate someone after cardiac cath or fail to compress the radial artery
Pseudoanyeursm
Can threaten the function of the hand as a whole; if > 2 cm or expands rapidly, may need surgical intervention
Level at which a 1mg dexamethasone suppression test is positive
> 5
Hepatosplenic candidiasis
Presents in patients w/ acute leukemia, prolonged neutropenia, and/or long term vascular access; often times septic w/ RUQ pain
Labs/Imaging: Elevated AP, hypodensities in the spleen, liver, and sometimes kidneys
Patients should remain on antifungal therapy as long as they are expected to be neutropenic
Treatment of Barrett’s with associated dysplasia
Endoscopic ablation
Tool to use to grade whether someone should undergo urgent angiography
TIMI score
Elevated opening pressure on LP
> 20mmHg
Secondary focal segmental glomerulosclerosis
Most common form of FSGC in black persons and accounts for 40% of idiopathy nephrotic syndromes
Patients typically have subnephrotic range proteinurea due to effacement of the podocytes due to hyperfiltration reactive changes
Found in black persons, obese persons, and premature born people
Lipoprotein glomerulopathy
Characterized by mod-severe proteinurea, progressive renal failure, and biopsy revealing glomerulocapillary dilation due to lipid thrombi
<100 cases ever reported so this is not a great card lol
Treatment for chronic cervical stenosis
Physical therapy + pain control
Eval of hypercortisolism
Initial testing (should include 2):
- Low dose dexamethasone suppression
- 24hr urinary cortisol
- Late-night salivary cortisol
If positive =» ACTH level
If high =» Pituitary MRI
In what situation does Hungry Bone Syndrome occur?
Occurs post-parathyroidectomy when calcium suddenly enters the bone matrix from the serum due to sudden loss of PTH
What medications are NOT helpful in treating SLE?
TNF-a inhibitors. In fact, may make disease worse
What medication can be used to treat refractory SLE on multiple immunomodulating therapies?
Belimumab, a B-lymphocyte stimulator inhibito (BLyS). This marker plays a substantial role in the development of SLE and is indicator for mild-moderately active lupus in addition to standard therapies
Testing following treatment for H. pylori
At 4 weeks, you can confirm eradication via:
- Urea breath test OR
- Monoclonal stool antigen testing
Work up for single, isolated inguinal lymph node
Perianal inspection (and genital) and anoscopy
Treatment of ulcers in Behcet’s Syndrome
Topical Glucocorticoids
Tumoral Calcinosis
AR disorder affecting FGF-23, the major phosphaturic hormone
=» Increased phosphorus reabsoprtion in the PCT
-Patients may have tumor-like calcifications
Tx: Low phosphorus diet
Low FEV1, normal FEV1/FVC ratio, normal DLcO
Obesity Hypoventilation Syndrome
Patient with systemic sclerosis who now has diarrhea with most meals
SIBO
40-70% of patients with DSSc have decreased small bowel motility that leads to SIBO
Dx: Glycogen breath test or jejunal aspirate culture
Tx: Screen for deficiencies, rotate abx, try probtioics (nothing perfect to do)
Scoring system to evaluate a TIA patient’s risk for stroke in the next 48 hours
Age - 60 or older B- >140/>90 C- clinical features (+2 if unilateral weakness; +1 for speech only) D- duration of symptoms D- diabetes
When to treat prostate cancer bone mets with zoledronic acid
If they are castrate resistant
IF they are susceptible to ADT, only need to treat with this HOWEVER these patients to need DEXA prior to therapy to screen for underlying osteoporosis so they may need it anyways
Superficial venous thrombosis management
ASH: Anticoagulation for 6 weeks if ≥5 cm in length, close to the deep venous system, or other thrombophilic risk factors exist
CHEST: Fondaparinux for 45 days if increased risk for clot progression (extensive SVT; involvement above the knee; severe symptoms; involvement of the greater saphenous vein; history of DVT, PE, or SVT; active cancer; recent surgery)
If not anticoagulated, follow up in 1 week and image if symptoms are persistent or worsening
Protamine adverse effects
Protamine adverse effects include allergic reactions, hypotension, bradycardia, and respiratory toxicity.
Side effect of PPIs
Hypomagnesemia has become increasingly recognized in patients taking proton pump inhibitors (PPIs) and is listed as a potential adverse effect in package inserts. The longer duration a person has been taking PPIs, the greater the likelihood of developing hypomagnesemia.
Because urine magnesium levels are low in patients with hypomagnesemia, the presumed mechanism is believed to be inhibition of the magnesium transporters in the gastrointestinal tract. Recent genomic analysis has identified a genetic polymorphism in the TRMP 6 magnesium transporter in patients with PPI-induced hypomagnesemia. Until the hypomagnesemia is corrected, the kidney will continue to waste potassium, making correction of hypokalemia difficult.
