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
- Screen alcohol use disorders routinely to catch those of whom do not appear to have a significant social or occupational impairment.
- Use assertive statements to convey the concern regarding someone’s alcohol use.
- 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.
- Medical treatments may be considered in select patients: naltrexone, acamprosate, disulfiram.
Gout – Dr. Hyon Choi
- Screen for HLA-B*5801 in Asians (esp. Chinese, Thai, and Korean patients) before starting alopurinol.
- Look for concurrent metabolic disorders.
- “Medication in the pocket” strategy for acute flares: colchicine 1.2mg po x1 then 0.6mg po in 1 hour.
- Use losartan or CCB for concurrent hypertension.
- Low-carb diet and avoid foods with highest purine content.
Cellulitis – Dr. Val Montessori
- Non-purulent cellulitis, most likely caused by Group A Strep, treat with cephalexin (Keflex) 500mg po QID
- Purulent cellulitis, most likely Staph Aureus but still possibly GAS, treat with Septra DS PO BID, and cover GAS with Keflex.
- Complicated wounds, consult ID.
HCV – Dr. Edward Tam
- New therapy more tolerable and has a 95% cure rate, but also exceedingly expensive.
- Refer all HCV RNA positive patients to hepatologists for assessment of treatment.
This Changed My Practice – Dr. Steve Wong
OSA – Dr. Pearce Wilcox
- Co-morbidities with metabolic syndrome -> screen for metabolic syndromes in patients with OSA, and vice versa