Learn from life @RVA, U.S.A.

1. R/O 2ndary: like smoker, COPD(chronic hypoxia), RCC 2. Labs: EPO, JAK-2, UA(R/O RCC) for ddx. primary vs 2ndary             3. Tx: IVF, Phlebotomy HCT> 50.

1. Apixaban = 5mg po bid(afib) vs 10mg bid for 7d -> 5mg bid. (for AFib = redosing) Age>80 Wt<60 Cr>1.5 = 2/3 = 2.5mg po bid 2. GFR<25 = contraindication! (in general <30 = NOAC contraindication) 3. Transition from Warfarin INR < 2: start Eliquis cf> Transfion from Warfarin to Ribaroxaban INR <3: start Xarelto. 4. Otherwise better than Warfarin with lower ICH for afib prevention !!!

SUMMARY AND RECOMMENDATIONS ● Patients diagnosed with thoracic aortic aneurysm (TAA) should be evaluated for possible underlying genetic syndromes known to be related to thoracic aortic aneurysm and dissection (TAAD). The patient should also be evaluated for other associated aneurysms (eg, brain, abdominal aorta, mesenteric, iliac, femoral, or popliteal arteries) using computed tomographic (CT) angiography or ultrasound. Among symptomatic patients, this evaluation is obtained postoperatively. (See  'Management of asymptomatic TAA'  above and  'Identifying associated genetic conditions'  above and  'Identifying associated aneurysm'  above.) ● The natural history of TAA is one of progressive expansion. The rate of expansion depends upon the location and diameter of the aneurysm and its underlying etiology. Most TAAs produce no symptoms. Patients with asymptomatic TAA should be followed for the development of signs and symptoms that may be associated with th

Hypoalbuminemia  can be  caused  by various conditions, including nephrotic syndrome, hepatic cirrhosis, heart failure, and malnutrition; however, most cases of hypoalbuminemia  are  caused  by acute and chronic inflammatory responses. Serum albumin level is an important prognostic indicator CHF, LC, NS, Maln utrition or Acute/chronic inflammation. Do not treat itself. Find out cause !! 

Heroin/Opioid overdose -> withdrawal. Sx> Anxiety, Pain, Diarrhea, Lacrimination/Rhinorrhea, N/V, HTN Objective eval> COW score(>7 will be indicated for treatment.) AP> 1. Wait for previous opioid clearance(for 4times of half life. Oxy 3HR X4 = 12HR) 2. Restless and BP: Ativan + Clonidine     N/V/Agitation: Compazine/ Promethazine /Hydroxyzine + Benadryl 3. m. pain: Dicyclomine, Baclofen, Tylenol, NSAIDS 4. Diarrhea: Loperamide And 5. Suboxone protocol (4mg Q12HR -> 8mg Qday -> 4mg Qday -> 2mg Qday) 6. Consult for methadone protocol: super long action. (10mg once - would not cause toxicity)

Intro. Population vs. Sample Good sampling -> assume all population appropriately. (Good representation) -> (Correct generalization) I. What kind of data?  1. Qualitative( alphabet) measured:  binary(2),  multilevel = Politative?(multiple)  a. nominal = sex(F M)  b. ordinal = grade(ABCD)  - a, b = will be described with frequency vs proportion(or percentage)  - proportion, percentage: complement rule(success + fail = 1 or 100%) 2. Quantitative(numeric =mathematical)  measured:  Continuous(uncountable, like height),                                                                                     Discrete(countable, finite like number of pt.)  a. interval = temperature(not meaningful zero)  b. ratio = speed(meaningful zero = absence)  - a vs b = only meaningful zero or not. II. how to describe group? 1. Representative of data = 'center'   - Informative strength = Mean > Median >>>> Mode   - Mean: all factors matter   - Median: good

Practical approach to cardiac stress test  Ref. Uptodate:  https://www.uptodate.com/contents/selecting-the-optimal-cardiac-stress-test?search=cardia%20stress%20test&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Dr. Ellenbogen's recommendation [ ] Can I obtain Dr. Hundley's presentation? Modality  Stress: Ex vs. Chemical  Detector: EKG vs. ECHO vs. Nuclear vs. cMRI Ex and normal EKG = Ex EKG -> good for limited candidate with some benefit(Px) (Not for : LBBB, V-Pacing, LVH = masking.                 >1 ST depression, WPW, Prior PCI.                for viability test) Ex and ECHO = not appropriate Ex and Nuclear = possible Ex and cMRI = not applicable Chemical and EKG = no Chemical and ECHO = Good for someone with ICD/PM patient.(Preferred than nuclear test)  => is it true??? Chemical and Nuclear = TRY TO AVOID THIS(prolonged process, not for ICD/PM) (basically interchangable to Chemical and ECHO excep