Internal medicine hub

🤢 Chemotherapy induced N&V: 1- categories patient based on chemotherapy to: If patient on parental chemo: - High emetic risk >90% - Moderate emetic risk 90-30% - Low emetic risk 30-10% - Minimal emetic risk <10 if on oral chemo: - Moderate to High >30% - Minimal to Low <30% 2-Prevention of CINV: for high emetic risk: (option A) - 1D: olanzapine, NK1RA (aprepitant) 5-HT3RA (ondasetron) and dexamethasone - 2-4D: olanzapine, NK1RA (aprepitant) and dexamethasone For moderate emetic risk: (option D) - 1D: 5-HT3RA (ondasetron) and dexamethasone - 2-3D: 5-HT3RA (ondasetron) and dexamethasone For low emetic risk: - 1D: dexa or metoclopramide or prochlorperazine or 5-HT3RA (ondasetron) For minimal emetic risk: no prophylaxis For moderate to high emetic risk: 5-HT3RA (ondasetron/Granisetron) For minimal to low emetic: PRN 3- Breakthrough N&V: - add agent from different class to current regiment: olanzapin, lorazepam, scopolamine, promethazine, 5-HT3RA or dexa - continue breakthrough med on schedule not PRN - Consider upgrade level of emetic risk next cycle Reference: CNNC guidelines 2024

Urine cast & AKI type:

Answer is C, nephrotic syndrome Nephrotic syndrome defined as - >3.5 g/day of proteinuria - hypoalbuminemia - peripheral edema - hyperlipidemia (and oval fat body)

🚫 Don’t be tricked: Platelets transfusion is contraindication in - TTP - HUS - HIT

🚫 don’t be tricked: Conditions characterized by low platelet counts but a high risk of thrombosis: 1- TTP 2- DIC 3- APS 4- PNH 5- HIT

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💊 Indication to initiate anti-hypertension meds: - if BP ≥130/80 plus high CV risk (HF, CKD, T2DM, ≥65 yrs old or 10-y ASCVD risk ≥10%) - if BP ≥140/90 regardless CV risk

ITP acute management, UTD

ITP management summary and tips

🩸 Bleeding risk in thrombocytopenia: - if plt count 100K-50K: risk of bleeding with major truama - if plt count <50K: risk of bleeding with minor trauma or surgery - if plt count <20K: risk of spontaneous bleeding - If plt count <10K: risk of life threatening bleeding

💊 Indications & CI for Dobutamine and Adenosine in Pharmacologic Stress Myocardial Perfusion Imaging (MPI): Dobutamine: using ECHO - indication: suspected ischemia with wall motion abnormalities and to assess valves (known valvular disease) - CI: tachyarrhythemia, recent MI (7 days) and uncontrolled HTN Adenosine: using PET scan - indication: quantify ischemia burden and perfusion defect - CI: severe asthma, COPD, heart block and hypotension

🫀 stable angina evaluation: Stable angina + normal ECG: - Exercise Stress Test Stable angina + LVH on ECG: - Stress Echocardiography - Myocardial Perfusion Imaging (MPI) with SPECT or PET Stable angina + Unable to Exercise: - Pharmacologic Stress Echocardiography (using dobutamine) - Pharmacologic Myocardial Perfusion Imaging (using adenosine or regadenoson)