Internal medicine hub

Subchondral gull erosion

Have you heard of subchondral “gull-wing” appearance 🤔? Subchondral gull-wing erosion is a feature of erosive OA

Inflammatory vs. noninflammatory pain features of inflammatory are: joint swelling, warmth or redness, prolonged morning stiffness (>30 min), improvement of pain/stiffness with motion/exercise

Is the source of pain articular or periarticular 🤔? typically active ROM more painful than passive ROM in periarticular process

Asthma management: GINA guideline 2024

Anti-heart failure meds increase survival: - ACEI / ARBs / ARNI - beta blockers - hydralazine + nitrate - spironolactone - SGLT2 inhibitors ** ICD

When to hold DOAC before procedure

European Society of HTN guideline 2024

Forms of nephrotic syndrome based on response to steroids

💡 Dont be tricked: chemical pneumonitis does not require antibiotic therapy. Appropriate treatment is supportive care Indication of Abx in chemical pneumonitis: - symptoms persist longer than 48 hours - patient on PPI bacterial aspiration pneumonia: would be suspected if these clinical and radiographic findings developed days, not hours, after a known aspiration event.

Lung abscess treatment lines: - ampicillin-sulbactam (IV) - carbapenem - clindamycin For patients who are allergic to penicillin: - moxifloxacin - levofloxacin plus metronidazole - ceftriaxone plus metronidazole

📍 ID tips: Vancomycin to cover MRSA NOT indicted unless: - prior respiratory isolation of MRSA - recent hospitalization with IV Abx Daptomycin is NOT approved for treating MRSA related pulmonary infections