EKG COMPETITION 11/09

In order to win this competition, please submit the appropiate diagnosis, including the rhythm.

HINT: The chest leads on this EKG are R precordial

If more than one person submits appropiate answer, the winner of the $25 gift card will be elected by lottery.

SORRY GUYS BUT NO ONE GOT THE COMPLETE ANSWER, AS DESCRIBED BY VALENTIN THERE ARE P WAVES EMBEDDED IN THE T WAVES, AND THIS PATIENT HAS 2ND DEGREE AV BLOCK WITH CONDUCTION 2:1, WHICH CAN HAPPEN IN PATIENTS WITH PROXIMAL OCCLUSION OF THE RCA. THE ST ELEVATION ON II, III, AVF GIVES THE DIAGNOSIS OF INFERIOR WALL MI, THEN R PRECORDIAL LEADS WERE DONE LOOKING FOR EVIDENCE OF RV INFARCTION, ST ELEVATION IN V4R DEMONSTRATES THAT THERE IS RV INFARCTION.

ANSWER:

INFERIOR WALL STEMI WITH RV INFARCTION, 2ND DEGREE AV BLOCK WITH CONDUCTION 2:1

 

Heart failure Algorithm (Updated ACC/AHA guidelines 2009)

 

COMPETITION 09 /2009

Question :

a non -smoking 26 y/o female sees an internist for evaluation for a 5 month HX of cough , wheezing , nasal congestion & wt loss . she repoorts no reflux . she immigrated from Guyana 5 yrs ago & had no significant PMH in her native country . she took no medications until recentky when she was treated with abx , inhaled & systemic steroids  & Albuterol in the ED . despite therapy symptoms have persisted & a leuko riene inhibitor was added with little relief of symptoms . LAbs were noted for a leuckocytosis (28000 ) with with a differential of 58% eosinophils (16000) . ESR was 37 . serum chemistry was unremarkable with negative ANA . PFT’s showed FVC 61 % with FEV 1 65 % with broncho dilator response. FEV1/FVC 85 : TLC 65% . Functional residual capapcity 50 % : residual vol 54 % : DLco 54 % : ABG showed Ph 7.41 : Pco2 : 36 PO2 102: O2 sat 98 % on RA & A-a grad of 5 . Chest X ray reveals a fine interstitial infiltrate. & CT shows a fine nodular pattern in both middle & lower lung fields :

 

Q1 : which of the following diagnostic approach is most appropriate to assess the pt’s condition :

A : perform bronch with BAL :

B : measure serum IgG 4 level:

C perform open lung Biopsy :

D : perform aspergillus ppt

E : test for OVA & parasites stool

Q 2 :

which of the following is the most appropriat treatment ?

A : amphotericin :

B diethyl carbamazapine :

c: Inhaeld steroids :

D : itraconazole :

E : Systemic steroids

 

 

 

August 2009 Pharmacy News letter

Pharmacy news letter

 

Competition 07/30/09

The Winner of this week’s Blog is Dr. Jigar Patel, PGY1

CONGRATULATIONS!!! Answers are below—

Winner of $25 gift card

Qustions Courtesy American College of Gastroenterology

Competition-073009

Answer Qs 1:

It is a calcified Hydatid Cyst

E. Continued observation with serial cross-sectional imaging to assess for stability

Explanation: This patient presents with an incidentally-noted, large, calcified cystic lesion of the liver. Echinoococcus is endemic to large parts of the Middle East, China and Latin America. The presence of daughter cysts as seen on the ultrasound strongly suggests the diagnosis of echinococcal (hyatid) liver cysts. Humans are accidental hosts and do not play a role in the life-cycle of the organism.

The natural history of hepatic echinococcal cysts is variable, with some patients having stable or slow-growing cysts and others presenting with spontaneous rupture and anaphylaxis. Calcification in the wall of the cyst suggests an inactive cyst. Asymptomatic calcified cysts frequently remain symptom free and treatment is not indicated unless there is evidence of growth (suggesting cyst activity) or the patient develops symptoms.

Ultrasound-guided aspiration (choice A) is incorrect because simple aspiration can lead to cyst content spillage and anaphylaxis. Oral metronidazole (choice B) is the therapy of choice for amebic liver abscesses caused by Entamoeba histolytica. Oral albendazole (choice C) is indicated for patients with inoperable cysts or for cysts in multiple organs. Medical therapy is not indicated for patients with calcified cysts. Surgical resection (choice D) is not indicated for patients with calcified cysts.

Qs 2:

MALT Lymphoma

 

H1N1 guidelines

 CDC Link: http://www.cdc.gov/h1n1flu/?s_cid=h1n1Flu_outbreak_026

H1N1 guidelines

Submitted by Alex Lyakhovetskiy, Pharm.D, BCPS
Clinical Pharmacy Specialist
Lincoln Medical and Mental Health Center

 

Pneumonia guidelines – updated

Pneumonia guidelines – updated

Submitted by Frank Piacenti PharmD
Infectious Diseases Clinical Pharmacist
Lincoln Medical Center
Pneumonia_flow_sheet_2009

 

Shabarek’s corner- 06/08/09

New Images

1. CT scan (hint-patient had a stroke) – MCA thrombus 2. Interesting x-ray of pelvis- note calcified iliac and femoral arteries, (click on link): Image-060809

Answer from previous question:  Retrocardiac pneumonia:  left retrocardial density- see CT scan: Previous X-ray answer

 

Thanks to Dr. Shabarek

 

H1N1 Influenza

CDC H1N1 website for clinicians: http://www.cdc.gov/h1n1flu/clinicians/

Infectious Disease Society of America Practice Guidelines- IDSA Flu Guideline 2009

 

Shabarek’s corner- 05/15/09

Decipher the x-ray

-x-ray given by Mana Keihanian, PGY1 and Dr. Shabarek