All posts by billy

About billy

Resident physician in family medicine. Favorite podcasts: BS Medicine, Surgery 101, Merck Manual of Patient Symptoms, ER Cast, Annals of Internal Medicine, PedsCases.

What I learned from St Paul’s CME 2014 Part 1

This is planned to be an 8-part series highlighting the take-home points I picked up during the St. Paul’s Hospital CME Conference 2014.

Pearls from Part 1 “Internal Medicine”:

Alcoholism – Dr. Paul Farnan

  1. Screen alcohol use disorders routinely to catch those of whom do not appear to have a significant social or occupational impairment.
  2. Use assertive statements to convey the concern regarding someone’s alcohol use.
  3. Peer support is strongly recommended. Patients should try multiple meetings at different groups before concluding that they are not helpful, as the groups vary in their structure and member characteristics.
  4. Medical treatments may be considered in select patients: naltrexone, acamprosate, disulfiram.

Gout – Dr. Hyon Choi

  1. Screen for HLA-B*5801 in Asians (esp. Chinese, Thai, and Korean patients) before starting alopurinol.
  2. Look for concurrent metabolic disorders.
  3. “Medication in the pocket” strategy for acute flares: colchicine 1.2mg po x1 then 0.6mg po in 1 hour.
  4. Use losartan or CCB for concurrent hypertension.
  5. Low-carb diet and avoid foods with highest purine content.

Cellulitis – Dr. Val Montessori

  1. Non-purulent cellulitis, most likely caused by Group A Strep, treat with cephalexin (Keflex) 500mg po QID
  2. Purulent cellulitis, most likely Staph Aureus but still possibly GAS, treat with Septra DS PO BID, and cover GAS with Keflex.
  3. Complicated wounds, consult ID.

HCV – Dr. Edward Tam

  1. New therapy more tolerable and has a 95% cure rate, but also exceedingly expensive.
  2. Refer all HCV RNA positive patients to hepatologists for assessment of treatment.

This Changed My Practice – Dr. Steve Wong

OSA – Dr. Pearce Wilcox

  1. Co-morbidities with metabolic syndrome -> screen for metabolic syndromes in patients with OSA, and vice versa


Family Pharm Podcast – RELAUNCHED!

After a 6-month hiatus, Tina – now a newly-hatched PHARMACIST! – and Billy teamed up to relaunch this pet project with a plan to make it more interactive and less sleep-inducing. Did it work with this unscripted episode?

ADHD 2: medications

Tina concentrates on the details of ADHD medications and invites your attention to the following:

Non-pharmacological therapy

  • behavioural therapy


  • methylphenidate
  • amphetamines


  • atomoxetine
  • clonidine
  • other antidepressants and antipsychotics (to be covered in future episodes)