Category: Med Blog


Some Tid-Bits
  • Four factors lead to acne formation: increased sebum production, hyperkeratinization, propionibacterium acnes colonization, and inflammatory reaction.
  • Treatment Steps (from mild to severe)
    1. Comedones – Rx Topical Retinoids (Tretinoin, Adapalene, Tazarotene) – generally works about the same. For the following additional symptoms:
    2. Inflammation – Add Topical Non-Abx (Benzoyl Peroxide, Azelaic Acid) +/- Topical Abx (
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    Some Facts:
  • Insomnia (ICSD-3 Definition) – Difficulty falling asleep, difficulty staying asleep, early awakening, daytime impairment (i.e. fatigue, poor concentration, moody, increased errors, social dysfunction, worry). Occurs at least 3x per week x1 month. Chronic if >3 months.
  • Comorbid Conditions – OSA/breathing disorders, circadian rhythm disorders, GI issues, pruritus, heart failure, pain, restless legs syndrome, nocturia, medication side effects, psych
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    Erectile Dysfunction

  • Check for psych factors, medications that may cause ED, and possible medical contributions to ED (DM2, obesity, CAD). Do physical exam to check for hypogonadism, peyronie’s disease, or other possible causes of ED.
  • Labs
  • Total testosterone level (deficient if <300), TSH, lipid panel, A1C. Remember, ED can be a sentinel marker for CAD.
  • First-Line Treatment
  • Phosphodiesterase-5 Inhibitors – all
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  • Definition: >10° lateral curve to spine with vertebral rotation
  • Types: classified as congenital, neuromuscular, or idiopathic. Idiopathic scoliosis is further classified by age: Infantile (0-2 yo), Juvenile (3-9 yo), Adolescent (>10 yo).  Adolescent Idiopathic Scoliosis is the most common form.
  • Etiology unknown. Likely polygenic.
  • Risk factors for disease progression – initial Cobb angle (angle of curvature of spine) most
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  • USPSTF recommends all women 65 years and older get screened for osteoporosis with a DEXA scan to measure bone density.
  • You can also screen for osteoporosis in women younger than 65 who score high on the FRAX WHO Fracture Risk Assessment Tool.
  • USPSTF does not recommend routine screening in men unless they are older than 50 and have
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    Risk Classifications Schemes
  • Caprini Risk Assessment – estimates venous thromboembolism risk for non-orthopedic surgeries. Low risk use SCDs. Mod risk use meds or SCDs. High risk use meds+SCDs. If risk of bleeding, use SCDs only.
  • CHADS2 – estimates stroke risk in Afib patients. Easiest one to use. Recommends aspirin, anticoagulant, or both, depending on risk.
  • CHA2DS2-VASc – a more accurate
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    Facts about Onychomycosis
  • Onychomycosis is very common. 50% of patients older than 70 years old have it.
  • Onychomycosis is most often caused by dermatophytes of the genus Trichophyton. Non-dermatophyte molds are less common.
  • Treating onychomycosis is more than just about cosmetics. It can lead to cellulitis in the elderly, and foot ulcers in diabetics.
  • Onychomycosis is hard to treat, since
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    Treatment for Allergic Rhinitis

    When treating allergic rhinitis, you should take into account the severity of symptoms, patient’s age, whether they are pregnant or not, price, and other factors. For asthmatics, allergic rhinitis is especially important to be treated as it can lead to asthma exacerbation. And of course, one should try to avoid known allergens as well. For Mild Intermittent Symptoms:
  • Second Generation
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    Nausea and Antiemetic Medications

    Nausea and vomiting happens when the Vomiting Center in the medulla is stimulated by one of three different neurotransmitter pathways:
  • Visceral Stimulation (of intestines, stomach) – i.e. nausea from gastroenteritis
  • mediated by dopamine and serotonin
  • Chemoreceptor Trigger Zone (in medulla oblongata) – i.e. nausea from chemotherapy
  • mediated by dopamine and serotonin
  • Vestibular Stimulation (in inner ear) – i.e. nausea from
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    Skeletal Muscle Relaxants

    Skeletal Muscle Relaxants can be prescribed for musculoskeletal pain only if you find no relief with acetaminophen or NSAIDs. Skeletal muscle relaxants have not been proved to be more effective than acetaminophen or NSAIDS, and because of the side effects and lack of evidence for long-term efficacy, they should only be prescribed if Acetaminophen or NSAIDs have failed, and should… Continue reading


    ERYSIPELAS – caused by strep
    1. Penicillin, Amoxicillin, Ampicillin (covers strep specificallly) CELLULITIS – caused by strep and staph
    No Abscess or pustular drainage – likely MSSA, MSSE
    1. Cephalexin, Dicloxacillin – PO, for minor infxn
    2. Oxacillin, Nafcillin, Cefazolin – IV, for more severe infxn
    Abscess or purulent drainage present – likely MRSA, MRSE
    3. TMP/SMX (Septra), Clindamycin, Doxycycline… Continue reading

    Eyelid Swelling

    Anatomy Zeis gland = sebaceous gland of eyelash (external)
    Moll gland = apocrine gland of external eyelid
    Meibomian gland = sebaceous gland of internal eyelid Pathology Infxn of Meibomian = internal hordeolum (internal stye)
    Infxn of Zeis or Moll = external hordeolum (external stye)
    Blocked Meibomian that is not infected (no pain, no erythema) = Chalazion Internal hordeolums can resolve… Continue reading

    Acute Limb Ischemia

    What is it? Acute limb ischemia happens when there is a sudden interruption of the blood supply in the arteries of the limb, with no time for collateral blood circulation to form. Causes There are three main causes of Acute Limb Ischemia:
    1. Thrombosis — 85%
    2. Embolus — 15%
    3. Vascular Trauma — <1%
    Thrombosis Thrombus can form in atherosclerotic arteries in… Continue reading