Family Practice Notebook Updates 2023

Aka: Family Practice Notebook Updates 2023, FPN Updates 2023

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II. Updates: December 2023

  1. Syncope (cv, sx)
    1. Updates
  2. Reactive Infectious Mucocutaneous Eruption (ent, mouth)
    1. Mucocutaneous eruption after a viral or Bacterial respiratory tract infection
  3. Thyroid Anatomy (endo, anatomy)
    1. Corrected Thyroid Anatomy image. Thanks to Dr. Falahi for pointing out the error
  4. Dog Bite (er, derm)
    1. Updates
  5. Closed Head Injury in Children (er, peds)
    1. Added
  6. Intravenous Pressure Bag (er, procedure)
    1. Updates to Intravenous Access
  7. Intraosseous Access (er, procedure)
    1. Updates to humeral IO
  8. Infectious Diarrhea (gi, Diarrhea)
    1. Updated intestinal protozoa infections (Giardia, Cryptosporidium, Cyclospora)
  9. Antibiotic Resistance (id, emerging)
    1. Updated MRSA, CRE, VRE
  10. Trichinosis (id, Helminth)
    1. Added
  11. Pinworms (id, Helminth)
    1. Updates
  12. Acyclovir (id, pharm)
    1. Updates to Acyclovir, Valacyclovir, Famciclovir
  13. Aminoglycoside (id, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  14. Chloramphenicol (id, pharm)
    1. Added
  15. Clindamycin (id, pharm)
    1. Updates
  16. CMV Antivirals (id, pharm)
    1. Added Cidofovir, Foscarnet, Ganciclovir, Valganciclovir, Letermovir, Maribavir
  17. Fluoroquinolone (id, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  18. Hepatitis C Antiviral Regimen (id, pharm)
    1. Updated for newer guidelines
    2. Created entries for each of the currently active agents, and updated their content
  19. Influenza (id, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  20. Interferon alfa (id, pharm)
    1. Updated Interferon Alfa-2B
    2. Added Peginterferon Alfa-2A
  21. Macrolide (id, Pharm)
    1. Created entries for each of the currently active agents, and updated their content
  22. Metronidazole (id, pharm)
    1. Updates
  23. Nitrofurantoin (id, pharm)
    1. Updates
  24. Oxazolidinone Antibiotic (id, pharm)
    1. Updated Linezolid and Tedizolid
  25. Ribavirin (id, pharm)
    1. Updated
  26. Sulfonamide (id, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  27. Tetracyclines (id, Pharm)
    1. Created entries for each of the currently active agents, and updated their content
  28. Dapsone (lung, pharm)
    1. Updates
  29. Ethambutol (lung, pharm)
    1. Updates
  30. Pleural Effusion (lung, pleura)
    1. Updates
  31. Rifamycin (lung, pharm)
    1. Updated Rifampin, Rifapentine and added Rifabutin
  32. Isoniazid (lung, pharm)
    1. Updated
  33. Pyrazinamide (lung, pharm)
    1. Updated
  34. Retrograde Intubation (lung, procedure)
    1. Added
  35. Difficult Clinical Encounter (manage, communication)
    1. Updated
  36. Electroencephalogram (neuro, procedure, Seizure)
    1. Updates including home EEG
  37. Termination of Pregnancy (ob, antepartum)
    1. Updates
  38. Autism (peds, neuro)
    1. Updates
  39. Hyponatremia (renal, Sodium)
    1. Updates
  40. Baricitinib (rheum, pharm)
    1. Added
  41. Bladder Irrigation (urology, procedure)
    1. Added

III. Updates: November 2023

  1. Hyperacute T Waves (cv, exam)
    1. Updates regarding how high does a T Wave need to reach to be considered significant (e.g. STEMI Equivalent)
  2. Wellens Syndrome (cv, exam)
    1. Updates regarding management
  3. BRASH Syndrome (cv, ekg)
    1. Updates
  4. Hypertension (cv, htn)
    1. Updates to evaluation and management
  5. Infantile Acropustulosis (derm, peds)
    1. Added
  6. Cantharidin (derm, pharm)
    1. Ancient drug extract from the Blister beetle has a new FDA indication for Molluscum Contagiosum at an unreasonable price ($700/application)
  7. Weight Loss Medication (endo, Obesity)
    1. Extensive updates
  8. HiNTs Exam (ent, Vertigo)
    1. Updates from Dr. Peter John's excellent video review (youtube)
  9. Peritonsillar Abscess (ent, mouth)
    1. Medical intervention (antibiotics, steroids) alone without aspiration has similar outcomes in uncomplicated PTA
    2. Medical management without aspiration has a similar failure rate as with aspiration (5 to 8%)
  10. Chronic Rhinosinusitis (ent, sinus)
    1. Updates
  11. Retained Guidewire in Central Venous Catheter Placement (er, procedure)
    1. Added to Central Line Placement
  12. Styrene Poisoning (er, toxin)
    1. Added
  13. Pelvic Inflammatory Disease (gyn, id)
    1. Updates
  14. Emergent Reversal of Anticoagulation (hemeonc, pharm)
    1. Updates
  15. Opportunistic Infections in HIV (hiv, id)
    1. Updates including to PCP, Cryptococcal Meningitis and Candidiasis
  16. HIV Infection (hiv, exam)
    1. Regularly screen for Suicidality
    2. Significantly higer risk of Suicidality in patients living with HIV
  17. Ill Returning Traveler (id, fever)
    1. Updates
  18. Covid Vaccine (id, immunize)
    1. Added new monovalent Vaccine
  19. Aztreonam (id, pharm)
    1. Added
  20. Glycopeptide Antibiotic (id, pharm)
    1. Created entries for each of the currently active agents, and updated their content (including Vancomycin)
  21. Piperacillin Tazobactam (id, pharm)
    1. Added
  22. Penicillinase-Resistant Penicillin (id, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  23. First Generation Cephalosporin (id, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  24. Second Generation Cephalosporin (id, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  25. Third Generation Cephalosporin (id, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  26. Advanced Generation Cephalosporin (id, pharm)
    1. Created entries for each of the currently active fourth and fifth generation agents, and updated their content
  27. Carbapenem (id, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  28. Daptomycin (id, pharm)
    1. Updates
  29. Paxlovid (id, pharm)
    1. Added its own entry (was already included in Covid19 treatment)
    2. Also added Molnupiravir
  30. Topical Antibiotic (id, pharm)
    1. Created entries for Bacitracin and Mupirocin
  31. Nirsevimab (id, immunize)
    1. Added RSV Monoclonal Antibody for RSV prophylaxis in all children
  32. RSV Vaccine (id, immunize)
    1. CDC recommends Pfizer Bivalent RSVpreF Vaccine (Abrysvo) single dose at 32 to 36 weeks during RSV season (U.S. Sept to Jan)
  33. COPD Exacerbation (lung, copd)
    1. Magnesium Sulfate has Bronchodilator effect related to inhibition of Calcium influx into Smooth Muscle Cells
    2. As of 2023, studies show similar effect as for Asthma (reduced hospitalization, length of stay, Dyspnea)
    3. Consider in severe COPD exacerbation (Magnesium Sulfate 2 grams IV over 20 minutes)
  34. CVA Management (neuro, cv)
    1. Endovascular therapy is performed within 24 hours of large vessel Occlusion and large prenumbra on perfusion imaging
    2. Previously limited to small infarcted cores, but as of 2023 evidence grows for large infarcted cores
  35. Nontraumatic Subarachnoid Hemorrhage (neuro, cv)
    1. Extensive updates
  36. Scapular Winging (ortho, Shoulder)
    1. Added
  37. Distal Radius Fracture (ortho, wrist)
    1. Updates including die punch Fracture
  38. Neuroimaging after First Seizure (neuro, rad)
    1. In Children MRI Head is the preferred modality if imaging is absolutely required (no radiation)
    2. MRI in young children requires sedation and increased resource use
    3. Consult pediatric neurology if imaging may be deferred to follow-up or tertiary transfer
    4. Larger, tertiary pediatric facilities have T3 MRI allowing rapid sequences and shorter MRI time
  39. Autism Spectrum Disorder (peds, neuro)
    1. Added associated cerebral Folate Deficiency (specifically Folate Receptor Alpha Autoantibodies)
    2. May respond to Leucovorin (Folinic Acid) Treatment
    3. Thank you to Dr. Alan Remde and Allotey Gustav for their alerting me to this association
  40. Brixadi (pharm, Opioid)
    1. Added
  41. Turmeric (pharm, alternative)
    1. Updates
  42. Medications in Pregnancy (ob, pharm)
    1. Updates to multiple topics related to OTC Medications in Pregnancy
  43. Appendicitis (surgery, gi)
    1. Equivocal Ultrasound findings are associated with surgical Appendicitis in 12 to 50% of pediatric cases
    2. Ultrasound scoring systems (e.g. Appy-Score) have been developed to risk stratify results
    3. Observing children, and repeating RLQ Ultrasound in 6 to 8 hours increases Test Sensitivity as disease progresses
  44. Transplant Anti-Rejection Drugs (surgery, transplant)
    1. Updated precautions
  45. Cryptorchidism (urology, peds, Testes)
    1. Extensive Updates

IV. Updates: October 2023

  1. Pericarditis (cv, Pericardium)
    1. Updates
  2. Tetralogy of Fallot (cv, peds)
    1. Updates including Tet Spell
  3. Finerenone (cv, pharm)
    1. Added
  4. Topical Antifungal (derm, pharm)
    1. Updates
  5. Inflammatory Linear Verrucous Epidermal Nevus (derm, hemeonc)
    1. Added
  6. Hyperaldosteronism (endo, adrenal)
    1. Extensive updates in diagnosis
    2. Thank you to Drs. Quencer, Rugge and Senashova in Portland, OR for their excellent AFP article (Sept 2023)
  7. GLP1 Agonist (endo, pharm)
    1. Semaglutide Updates
  8. SGLT2 Inhibitor (endo, pharm)
    1. Bexagliflozin added
    2. Empagliflozin updated
  9. Gestational Diabetes (endo, pharm)
    1. Updates
  10. Diabetes Mellitus Control in Hospital (endo, dm)
    1. Updates
  11. Tourniquet (er, procedure)
    1. Updates
  12. Hemlock Poisoning (er, toxin)
    1. Added
  13. Olfactory Dysfunction (ent, sx)
    1. Updates, including added Olfactory Training
  14. Proton Pump Inhibitor (gi, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  15. H2 Blocker (gi, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  16. Aluminum Hydroxide and Magnesium Hydroxide Antacid (gi, pharm)
    1. Added
  17. Simethicone (gi, pharm)
    1. Updates
  18. Sucralfate (gi, pharm)
    1. Added
  19. Misoprostol (gi, pharm)
    1. Updates
  20. Osmotic Laxative (gi, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  21. Stimulant Laxative (gi, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  22. Peripheral Acting Mu-Opioid Receptor Antagonist (gi, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  23. 5-HT3 Receptor Antagonist (gi, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  24. Neurokinin-1 Receptor Antagonist (gi, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  25. Postoperative Nausea and Vomiting (gi, pharm)
    1. Updates
  26. 5-Aminosalicylic Acid Derivative (gi, pharm)
    1. Updated Sulfasalazine, Mesalamine
    2. Added Balsalazide, Olsalazine
  27. Budesonide for Inflammatory Bowel Disease (gi, pharm)
    1. Added
  28. Hydrocortisone for Inflammatory Bowel Disease (gi, pharm)
    1. Added
  29. Eluxadoline (gi, pharm)
    1. Added
  30. Alosetron (gi, pharm)
    1. Added
  31. Constipation Dominant Irritable Bowel Syndrome (gi, pharm)
    1. Added Linaclotide, Plecanatide, Tenapanor, Prucalopride
    2. Updated Lubiprostone
  32. Rifaximin (gi, pharm)
    1. Added
  33. Tubo-Ovarian Abscess (gyn, id)
    1. Added
  34. Respiratory Syncytial Virus Vaccine (id, immunize)
    1. Updates
  35. Natural Penicillin (id, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  36. Endotracheal Intubation Preoxygenation (lung, procedure)
    1. Updates
  37. Delirium (neuro, cognitive)
    1. Updates
  38. Against Medical Advice (neuro, cognitive)
    1. Updates
  39. Emergency Department Migraine Headache Care (neuro, Headache)
    1. Updates
  40. Hyoscyamine (neuro, pharm)
    1. Added
  41. Dicyclomine (neuro, pharm)
    1. Added
  42. Morel-Lavallee Lesion (ortho, derm)
    1. Updates
  43. Melatonin (pharm, alternative)
    1. Updates
  44. Nalmefene (pharm, Analgesic)
    1. Updates with nasal form
  45. Refractory Depression Management (psych, depression)
    1. Updates
  46. Benzodiazepine Use Disoder (psych, cd)
    1. Added
  47. Brexpiprazole (psych, pharm)
    1. Now FDA approved for Agitation in Dementia
    2. But carries the same related black box warning, and in 2023, more than a $1000/month more than other agents
  48. Agitation (psych, behavior)
    1. Updates including to Agitation Management, Chemical Restraint
  49. Urine Pregnancy Test (ob, lab)
    1. Updates regarding False Negative UPT
  50. Calcium Carbonate (renal, pharm)
    1. Updates
  51. Metabolic Acidosis (renal, acidbase)
    1. Updates
  52. TNF Inhibitor (rheum, pharm)
    1. Created entries for each of the currently active agents, and updated their content
    2. Added Golimumab, Certolizumab
  53. Joint Injection (rheum, procedure)
    1. Updates regarding Hyperglycemia following injection
  54. Integrin Receptor Antagonist (rheum, pharm)
    1. Added Drug Class, as well as individual drugs in class
  55. Ustekinumab (rheum, pharm)
    1. Added
  56. Distal Intestinal Obstruction Syndrome (surgery, gi)
    1. Added
  57. Foreskin Dilation (urology, procedure)
    1. Added

V. Updates: September 2023

  1. Brainstem Cerebrovascular Accident (neuro, cv)
    1. Updates, thanks to Dr. Sourabh Jain
  2. Toxic Shock Syndrome (id, fever)
    1. Updates
  3. Syphilis (id, std)
    1. Updates
  4. Abdominal Compartment Syndrome (gi, cv)
    1. Updates
  5. Acute Pelvic Pain (gyn, sx)
    1. Updates
  6. Mittelschmerz (gyn, ovary)
    1. Added
  7. Pressure Injury (surgery, derm)
    1. Updates
  8. Abnormal Vital Signs (cv, exam)
    1. Updates
  9. Heart Valve Replacement (cv, surgery)
    1. Updated Anticoagulation
  10. Fecal Transfer (gi, pharm)
    1. Added
  11. Medication Use in the Elderly (geri, pharm)
    1. Updates
  12. Pneumonia Management (lung, id)
    1. Added Hydrocortisone for severe CAP
  13. Stimulant Medication (peds, pharm)
    1. Updates regarding stimulant misuse
  14. Testosterone Replacement (urology, endo)
    1. Updates regarding risk
  15. Crohns Disease (gi, ibd)
    1. Updated Biologic Medications
  16. Prenatal Care (ob, exam)
    1. Extensive Updates
  17. Acute Liver Failure (gi, liver)
    1. Updates including to Acute Hepatitis
  18. Chronic Liver Failure (gi, liver)
    1. Updates
  19. Liver Transplant (gi, surgery)
    1. Added
  20. Milk Thistle (pharm, alternative)
    1. Updates
  21. Ezetimibe (cv, pharm)
    1. Updates
  22. PCSK9 Inhibitor (cv, pharm)
    1. Created entries for each of the currently active agent, and updated their content
  23. Platelet ADP Receptor Antagonist (cv, pharm)
    1. Created entries for each of the currently active agent, and updated their content
  24. Antiplatelet Medications (hemonc, pharm)
    1. Added Cilostazol, Pentoxifylline
    2. Updated Dipyridamole
  25. Glycoprotein IIB/IIIA Inhibitor (hemeonc, pharm)
    1. Created entries for each of the currently active agent, and updated their content
  26. Direct Thrombin Inhibitor (hemeonc, pharm)
    1. Created entries for each of the currently active agent, and updated their content
  27. Thrombolytic (hemeonc, pharm)
    1. Created entries for each of the currently active agent, and updated their content
  28. Heparin (hemeonc, pharm)
    1. Updated Heparin, LMWH, Enoxaparin, Dalteparin
  29. Cardiac Action Potential (cv, ekg)
    1. Added and created image
  30. Thrombosis Pathway (hemeonc, exam)
    1. Created image
  31. Cardiorenal Syndrome (renal, cv)
    1. Added types, thanks to Dr. Sourabh Jain
  32. Joint Injection (rheum, procedure)
    1. Updates
  33. Food Allergy (ent, allergy)
    1. Updates
  34. Speech and Language Disorders in Children (peds, neuro)
    1. Updates
  35. DEET Poisoning (id, pharm)
    1. Added
  36. IUD Removal (gyn, procedure)
    1. Updates
  37. Atrial Flutter (cv, ekg)
    1. Updates
  38. Respiratory Panel (id, lab)
    1. Added
  39. Intraoral Sebaceous Hyperplasia (dental, mucosa)
    1. Updates
  40. Blunt Abdominal Trauma (er, gi)
    1. Updates
  41. Perioperative Anticoagulation (hemeonc, surgery)
    1. Updates
  42. Inhaled Bronchodilator (lung, pharm)
    1. Updates on short (SABA) and long acting (LAMA, LABA)
  43. Inhaled Corticosteroid (lung, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  44. Leukotriene Modifier (lung, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  45. Asthma Monoclonal Antibody (lung, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  46. Intranasal Corticosteroid (ent, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  47. Non-Sedating Antihistamines (ent, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  48. Sedating Antihistamines (ent, pharm)
    1. Created entries for each of the currently active agents, and updated their content
  49. N-Acetylcysteine (er, pharm)
    1. Updates
  50. Cromolyn Sodium (lung, pharm)
    1. Added for completeness
  51. Artificial Surfactant Replacement (lung, pharm)
    1. Added for completeness
  52. Alpha-1 Antitrypsin (lung, pharm)
    1. Added for completeness

VI. Updates: August 2023

  1. Modified Duke Criteria for Infectious Endocarditis (cv, id)
    1. Thanks to Dr. Sourabh Jain for recommendations for modifications
  2. Myotonic Dystrophy (neuro, motor)
    1. Added
  3. Preseptal Cellulitis (derm, id)
    1. Updated antibiotic coverage
  4. Clinical Event Debrief (manage, communication)
    1. Added
  5. Headache Causes
    1. Updated secondary causes
  6. BiPap (lung, procedure)
    1. Updated including adding Average Volume Assured Pressure Support
  7. Malignant External Otitis (ent, ear)
    1. Updates
  8. Pituitary Apoplexy (endo, pituitary)
    1. Added definition
  9. SGLT2 Inhibitor (endo, pharm)
    1. Another SGLT2 Inhibitor (Inpefa) is released
  10. Neurokinin 3 Receptor Antagonist (gyn, pharm)
    1. Added (for Hot Flashes)
  11. Social Determinants of Health (manage, exam)
    1. Updates
  12. Opioid-Induced Hyperalgesia (pharm, analgesia)
    1. Added
  13. Nitroglycerin (cv, pharm)
    1. Updated all Nitroglycerin forms of delivery
  14. Milrinone (cv, pharm)
    1. Added
  15. Digoxin (cv, pharm)
    1. Updated
  16. Dobutamine (cv, pharm)
    1. Updated
  17. Antiarrhythmic (cv, pharm)
    1. Updated Amiodarone, Adenosine, Quinidine, Atropine, Ibutilide, Flecainide, Lidocaine, Isoproterenol, Propafenone, Procainamide, Sotalol
    2. Added Disopyramide, Dronedarone, Dofetilide, Mexiletine
  18. Benign Paroxysmal Positional Vertigo (ent, vestibular)
    1. Updates regarding treatment maneuvers
    2. Epleys Maneuver is for the most common affected canal (posterior)
    3. Other maneuvers are for lateral and anterior canal involvement
  19. Menopause (gyn, Menses)
    1. Extensive updates on Estrogen Replacement Therapy, Hot Flushes, Atrophic Vaginitis
    2. Updates to Continuous Estrogen Replacement
  20. SERM (gyn, pharm)
    1. Added
  21. Pediatric Eye Exam (eye, peds)
    1. Updates to Pediatric Vision Screening and important eye conditions
  22. Respiratory Syncytial Virus (lung, id)
    1. Updates
  23. Fatigue (rheum, sx)
    1. Extensive updates including to Chronic Fatigue Syndrome
  24. Cerebrovascular Accident (neuro, cv)
    1. Updates to prevent of recurrence and management of complications
  25. Diabetic Ketoacidosis in Pregnancy (endo, ob)
    1. Added
  26. MPox (id, virus)
    1. Updates
  27. Tirzepatide (endo, pharm)
    1. Added
  28. Problem Drinking (psych, cd)
    1. Updated with Phosphatidylethanol Test
  29. Headache in Pregnancy (neuro, ob)
    1. Updates
  30. Osteoporosis Management (rheum, bone)
    1. Updates
  31. Propranolol (cv, pharm)
    1. Updates
  32. Deep Vein Thrombosis (hemeonc, cv)
    1. Extensive updates
  33. Giardiasis (gi, id)
    1. Updates
  34. Crohn Disease (gi, ibd)
    1. Updates
  35. Meckel's Diverticulum (surgery, gi)
    1. Updates
  36. Selenium Poisoning (er, toxin)
    1. Added
  37. Contrast Media Reaction (rad, pharm)
    1. Updates
  38. Subdural Empyema (neuro, id)
    1. Added
  39. Patellar Tendon Rupture (ortho, knee)
    1. Updates
  40. Statin (cv, pharm)
    1. Created entries for each of the currently active Statins, and updated their content
  41. Fibrates (cv, pharm)
    1. Created entries for each of the currently active Statins, and updated their content
  42. Bile Acid Sequestrants (cv, pharm)
    1. Created entries for each of the currently active Statins, and updated their content

VII. Updates: July 2023

  1. Growth Faltering (endo, peds)
    1. Updates
  2. Pericarditis (cv, Pericardium)
    1. Extensive Updates
  3. Esophageal Dysphagia (gi, Esophagus)
    1. Extensive updates, as well as to Esophagitis, Esophageal Perforation
  4. Nasogastric Tube (gi, procedure)
    1. Added placement technique
  5. Beta Blocker (cv, pharm)
    1. Updated and added all Beta Blockers
    2. Includes Metoprolol, Atenolol, Carvedilol, Labetalol, Esmolol, Propranolol, Nadolol, Pindolol, Timolol, Acebutelol, Betaxolol, Bisoprolol
  6. ACE Inhibitor (cv, pharm)
    1. Updated and added all ACE Inhibitors
    2. Includes Benazapril, Captopril, Enalapril, Fosinopril, Lisinopril, Moexipril, Perindopril, Quinapril, Ramipril, Trandolapril
  7. Angiotensin Receptor Blocker (cv, pharm)
    1. Updated and added all ARBs
    2. Includes Azilsartan, Candesartan, Irbesartan, Losartan, Olmesartan, Telmisartan, Valsartan
  8. Neprilysin Inhibitor (cv, pharm)
    1. Added
  9. Diabetes Sick Day Management (endo, dm)
    1. Updates
  10. Hyperlipidemia Management (cv, lipids)
    1. Updates
  11. Covid Vaccine (id, immunize)
    1. Updates
  12. Poison Ivy (ent, allergy, derm)
    1. Updates
  13. Medication Compliance (pharm, manage)
    1. Updates
  14. Obesity in Children (endo, peds)
    1. Updates
  15. Acute Abdominal Pain (surgery, gi)
    1. Updates
  16. COPD Management (lung, copd)
    1. Updates
  17. Benign Prostatic Hyperplasia (urology, Prostate)
    1. Updates
  18. Infertility (gyn, endo)
    1. Updates
  19. Paroxysmal Supraventricular Tachycardia (cv, ekg)
    1. Extensive Updates
  20. Tizanidine (rheum, pharm)
    1. Added/updated as individual entry
  21. Pyrethroid Toxicity (derm, pharm)
    1. Added
  22. EKG Lead Reversal (cv, ekg)
    1. Added to EKG Validity
  23. Meckel Diverticulum (surgery, gi)
    1. Updated
  24. Colorectal Cancer Screening (gi, prevent)
    1. Updated and added Circulating methylated tumor DNA as experimental
  25. Perilunate Dislocation (ortho, wrist)
    1. Updated
  26. Lateral Condyle Fracture (ortho, elbow)
    1. Updated
  27. Acute Paronychia (derm, nails)
    1. Updated
  28. Roseola Infantum (id, virus)
    1. Updates
  29. Chronic Kidney Disease (renal, failure)
    1. Updates regarding age, eGFR and CKD definition
  30. Hydralazine (cv, pharm)
    1. Added
  31. Aliskren (cv, pharm)
    1. Updated
  32. Fenoldopam (cv, pharm)
    1. Added
  33. Nitroprusside (cv, pharm)
    1. Updates
  34. Amlodipine (cv, pharm)
    1. Added
  35. Dihydropyridine Calcium Channel Blocker (cv, pharm)
    1. Added Amlodipine, Isradipine, Felodipine, Nisoldipine
    2. Updated Clevidipine, Nicardipine, Nifedipine
  36. Non-Dihydropyridine Calcium Channel Blocker (cv, pharm)
    1. Updated Verapamil, Diltiazem

VIII. Updates: June 2023

  1. Occlusion Myocardial Infarction (cv, cad)
    1. Updates
  2. De Winter T Wave (cv, exam, ekg)
    1. Updates
  3. Drug Reaction with Eosinophilia and Systemic Symptoms (ent, pharm, allergy)
    1. Updates
  4. Transcutaneous Pacing (cv, procedure)
    1. Updates
  5. Bronchiolitis (lung, peds)
    1. Updates regarding Albuterol
  6. Chronic Hypertension in Pregnancy (cv, ob)
    1. Updates
  7. Continuous Glucose Monitoring (endo, pharm)
    1. Updates
  8. Penicillin Allergy (id, pharm)
    1. Updates
  9. Direct Oral Anticoagulant (hemeonc, pharm)
    1. Updates regarding Drug Interactions
  10. Photosensitivity Reaction (derm, environ)
    1. Updates to Photosensitivity Reaction and Photosensitizer
  11. Negative Pressure Pulmonary Edema (renal, edema)
    1. Added
  12. Diffuse Alveolar Hemorrhage (lung, failure)
    1. Added
  13. Thiazide Diuretics (cv, pharm)
    1. Updated all Thiazide Diuretics and split them into their own entries
  14. Loop Diuretics (cv, pharm)
    1. Updated all Loop Diuretics and split them into their own entries
  15. Potassium-Sparing Diuretic (cv, pharm)
    1. Updated all Loop Diuretics and split them into their own entries
  16. Presynaptic Adrenergic Release Inhibitor (cv, pharm)
    1. Updated all agents and split them into their own entries
  17. Postsynaptic Alpha Adrenergic Antagonist (cv, pharm)
    1. Updated all agents and split them into their own entries
  18. Autoimmune Polyglandular Syndrome (endo, adrenal)
    1. Thanks to Dr. Sourabh Jain for recommendations to add APS1
    2. Also added IPEX, another polyendocrinopathy
  19. Serum Periostin (lung, lab)
    1. Thanks to Dr. Sourabh Jain for recommendations to add Periostin
    2. Increased in severe Allergic Asthma
  20. Extrinsic Asthma (lung, Asthma)
    1. Updates regarding types, physiology and biomarkers to both Extrinsic Asthma and Intrinsic Asthma
  21. Allergic Rhinitis (ent, allergy)
    1. Updates
  22. Pediatric Limp (rheum, sx, peds)
    1. Updates
  23. Disability (sports, Disability)
    1. Updates
  24. Shoulder Pain (ortho, Shoulder)
    1. Updates including to specific Shoulder-related conditions
  25. Vertigo (ent, vestibular)
    1. Updates to Dizziness and various causes
  26. Neonatal Jaundice (nicu, gi)
    1. Extensive Updates
  27. Thyroid Storm (endo, Thyroid)
    1. Updates
  28. Headache in Children (neuro, peds, Headache)
    1. Updates
  29. Zavegepant (neuro, pharm)
    1. Added
  30. Buspirone Toxicity (psych, pharm)
    1. Added
  31. EKG (cv, exam)
    1. Updated P Wave and T Wave normal morphology
  32. Cerebrovascular Accident in Children (neuro, peds)
    1. Updates
  33. Lactic Acidosis (renal, lab)
    1. Updates
  34. Cabotegravir (hiv, pharm)
    1. Added, including HIV PrEP indications
  35. Esophageal Foreign Body (gi, Esophagus)
    1. Updates
  36. Gastrointestinal Bleeding (gi, sx)
    1. Updates regarding Anticoagulation and antiplatelet agents
  37. Alzheimer Disease (neuro, cognitive)
    1. Added Lumipulse G biomarkers
  38. Substance Use Disorder in Pregnancy (psych, ob, cd)
    1. Updates
  39. Nonalcoholic Fatty Liver (gi, liver)
    1. Updates
  40. Ovarian Stimulation Syndrome (gyn, endo)
    1. Updates
  41. Serum Magnesium (renal, Magnesium)
    1. Updates to Hypomagnesemia and Hypermagnesemia
  42. Internal Cardiac Defibrillator (cv, procedures)
    1. Updates
  43. Alcohol Use Disorder (psych, cd)
    1. Updates
  44. Neonatal Fever (id, peds)
    1. Updates

IX. Updates: May 2023

  1. Systemic Lupus Erythematosus (rheum, diffuse)
    1. Extensive updates regarding management
  2. Leukemia (hemeonc, Leukemia)
    1. Extensive updates including Acute Leukemia, ALL, AML, Chronic Leukemia, CLL, CML, Hematopoietic Stem Cell Transplant
  3. Upper Gastrointestinal Bleeding (gi, sx)
    1. Extensive updates
  4. Bell Palsy (neuro, cn)
    1. Updates
  5. Neck Masses in Children (hemeonc, exam)
    1. Updates
  6. Bioterrorism (er, toxin)
    1. Updates
  7. Viral Hemorrhagic Fever (id, emerging)
    1. Updates
  8. Anthrax (id, Bacteria)
    1. Updates
  9. Plague (id, Bacteria)
    1. Updates
  10. Tularemia (id, vector)
    1. Updates
  11. Morel-Lavallee Lesion (ortho, derm)
    1. Added
  12. Prurigo Nodularis (derm, hyperplasia)
    1. Added
  13. Suppurative Tenosynovitis (ortho, id)
    1. Updates
  14. Rewarming Methods in Hypothermia (er, environ)
    1. Updates
  15. ATP-Citrate Lyase Inhibitor (cv, pharm)
    1. Added
  16. Long COVID (lung, id)
    1. Updates
  17. Over-The-Counter Medication Safety (pharm, prevent)
    1. Added
  18. Buprenorphine (pharm, Analgesic)
    1. Chronic Pain dosing added
  19. Anti-Amyloid Beta Plaque Monoclonal Antibody (neuro, pharm)
    1. Added Leqembi (another agent to avoid)
  20. Anticonvulsants (neuro, pharm)
    1. Added Brivaracetam, Lacosamide, Clobazam, Fosphenytoin, Ethosuxamide, Rufinamide, Vigabatrin
    2. Updated Cannabidiol, Carbamazepine, Oxcarbazepine, Eslicarbazepine, Gabapentin, Lamotrigine, Levetiracetam, Perampanel, Phenobarbital
    3. Also updated Pregabalin, Primidone, Topiramate, Zonisamide, Valproic Acid
  21. Amyloidosis
    1. Updates regarding Amyloidosis types
    2. Thank you to Dr. Sourabh Jain for his feedback regarding this topic
  22. Allergic Bronchopulmonary Aspergillosis
    1. Updates regarding diagnosis
    2. Thank you to Dr. Sourabh Jain for his feedback regarding this topic
  23. Asthma Management (lung, Asthma)
    1. Updates
  24. Covid19 (lung, id)
    1. Updates
  25. Acetaminophen Overdose (pharm, Analgesic)
    1. Fomepizole may play a role in late presentation of Acetaminophen Overdose
  26. Hydrogen Peroxide Poisoning (er, toxin)
    1. Updates
  27. Opioid Withdrawal (psych, cd)
    1. Updates
  28. Dorsal Penile Nerve Block (uro, procedure)
    1. Updates
  29. Chronic Low Back Pain (ortho, L-spine)
    1. Updates
  30. Postpartum Hemorrhage (ob, LD)
    1. Updates
  31. Aortic Stenosis (cv, valve)
    1. Updated, thanks for Dr. Sourabh Jain for his feedback regarding this topic

X. Updates: April 2023

  1. Intracerebral Hemorrhage (neuro, cv)
    1. Updates
  2. Ludwig's Angina (lung, airway)
    1. Updates
  3. Actinic Cheilitis (ent, lip)
    1. Added
  4. Procedural Sedation (surgery, Anesthesia)
    1. Updates
  5. Testicular Torsion (urology, Testes)
    1. Updates
  6. Low Risk Chest Pain (cv, cad)
    1. Updates
  7. Lung Nodule (lung, rad)
    1. Updates
  8. Hair Tourniquet (surgery, derm)
    1. Updates
  9. Nail Hyperpigmentation (derm, nail)
    1. Updates
  10. Cauda Equina Syndrome (ortho, L-Spine)
    1. Updates
  11. Digital Rectal Exam (gi, exam)
    1. Updates
  12. Clostridioides difficile (gi, id)
    1. Updates regarding Stool Transplant
  13. Pediatric Appendicitis Lab Score (surgery, exam)
    1. Added another Appendicitis scoring system
  14. Herpes Zoster (id, virus)
    1. Longterm increased cardiovascular and Cerebrovascular Disease risk (Growing evidence for association)
    2. Thank you to Dr. Wesam Khalfalla for contributing this information
  15. Visual Field Deficit (neuro, sx)
    1. Added
  16. Glaucoma (eye, Glaucoma)
    1. Extensive updates
  17. CVA Management (neuro, cv)
    1. Updates
  18. Parkinsonism Medications (neuro, Tremor)
    1. Updates to Levodopa-Carbidopa, Amantadine, several Dopamine Agonists, MAO Inhibitors Type B, Anticholinergics
  19. Guillain-Barre Syndrome (neuro, demyelinating)
    1. Extensive updates
  20. Transverse Myelitis (neuro, id)
    1. Extensive updates
  21. Headache-Related Neuroimaging (neuro, rad)
    1. Updates
  22. Spine Injury (ortho, sx)
    1. Updates to Cervical Spine Injury, Cervical Spine Fracture, lumbosacral injury
    2. Added SLIC and TLIC Scores for unstable spine Fractures
  23. Achilles Tendon Rupture (ortho, ankle)
    1. Updates
  24. Androgenic Alopecia (derm, hair)
    1. Updates regarding management in women
  25. Polycystic Ovary Syndrome (gyn, endo)
    1. Updates
  26. Ovarian Cancer (gyn, hemeonc)
    1. Updated markers including ROMA
  27. Enteral Tube (gi, procedure)
    1. Updates regarding medications
  28. MELAS Syndrome (endo, metabolism)
    1. Added
  29. Osteoporosis (rheum, bone)
    1. Updates
  30. Obstructive Lung Disease (lung, lab)
    1. Updates
  31. Post-Traumatic Stress Disorder (psych, anxiety)
    1. Updates
  32. DVT Anticoagulation (hemeonc, pharm)
    1. Suspend Aspirin or other Antiplatelet Therapy in stable cardiovascular disease while on VTE Anticoagulation
    2. Continue Aspirin and other antiplatelet agents only if clear indications (e.g. recent coronary stenting, Claudication)
    3. Otherwise preventive antiplatelet agents with Anticoagulation add significant bleeding risk without significant benefit
  33. Anticholinergic Poisoning (neuro, Anticholinergic)
    1. Updates regarding bicarbonate for QRS Widening and QTc Prolongation
  34. Benzodiazepines (psych, pharm)
    1. Updated all Benzodiazepine drugs in class
  35. Viloxazine (psych, pharm)
    1. Added NSRI as ADHD Medication (but high cost and adverse effects at low efficacy)
  36. Neurokinin-1 Receptor Antagonist (gi, pharm)
    1. Added
  37. Amisulpride (gi, pharm)
    1. Added
  38. Doxylamine (ent, allergy)
    1. Added
  39. Dimenhydrinate (ent, allergy)
    1. Added
  40. Metoclopramide (gi, pharm)
    1. Added
  41. Amtiemetic (gi, pharm)
    1. Added and updated multiple Antiemetics, broad review
  42. Hypertension Criteria (cv, htn)
    1. Updated Hypertension Criteria
    2. Thanks to Dr. Sourabh Jain for highlighting ACC/AHA update

XI. Updates: March 2023

  1. Genital Herpes in Pregnancy (id, ob)
    1. Thank you to Dr. Manuel Tu for correcting the Acyclovir prophylaxis dosing to 400 mg orally tid
    2. Other updates including adding Valtrex as an additional management option
  2. Skin Conditions of Pregnancy (derm, ob)
    1. Extensive updates
  3. Monkeypox (id, virus)
    1. Extensive updates
  4. Myocardial Dysfunction after Cardiac Arrest (er, exam)
    1. Updates
  5. CHF in Children (cv, peds)
    1. Updates
  6. Thrombotic Thrombocytopenic Purpura (hemeonc, Platelets)
    1. Updates
  7. Denusamab (rheum, med)
    1. Added, along with Hypocalcemia risk
  8. Group A Streptococcus (id, Bacteria)
    1. Updated regarding severe invasive disease
  9. Genitourinary Syndrome of Menopause (gyn, vagina)
    1. Updates
  10. Helicobacter Pylori (gi, id, pud)
    1. Extensive updates
  11. Kaposi Sarcoma (hemeonc, hiv)
    1. Updates
  12. Antipsychotic (psych, pharm)
    1. Added Asenapine, Brexpiprazole, Cariprazine, Lurasidone, Pimavanserin, Iloperidone, Paliperidone, Chlorpromazine, Fluphenazine
    2. Updated Aripiprazole, Ziprasidone, Clozapine, Olanzapine, Quetiapine, Risperidone, Haloperidol, Perphenazine, Molindone, Loxapine
  13. Depression Medical Management (psych, Depression)
    1. Extensive updates
  14. Inflammatory Bowel Disease (gi, ibd)
    1. Updates including Crohn Disease and Ulcerative Colitis
  15. Diverticulitis (gi, bowel)
    1. Updates
  16. Neonatal Vomiting (gi, peds)
    1. Updates
  17. Toxic Megacolon (surgery, gi)
    1. Added
  18. Potassium Chlorate (er, toxin)
    1. Added
  19. Otitis Externa (ent, ear)
    1. Updates
  20. Lever Test (ortho, exam)
    1. Added highly sensitive test for ACL Rupture (and an image)
  21. Nursemaid's Elbow (ortho, elbow)
    1. Updates
  22. Myofacial Pain Syndrome (rheum, myofascial)
    1. Updates
  23. Inducing Lactation in Adoptive Mothers (ob, Lactation)
    1. Added
  24. Lactogenesis (gyn, anatomy, Breast)
    1. Updated
  25. Gastrointestinal Opioid Antagonist (gi, pharm)
    1. Updated efficacy
  26. Atopic Dermatitis (derm, dry)
    1. Medium potency steroids are as effective as high potency steroids in Eczema management
  27. Religious Fasting During Ramadan (pharm, nutrition)
    1. Added
  28. End-Of-Life Care (hemeonc, psych)
    1. Updates
  29. Bug Fixes (manage, computer)
    1. Fixed dozens of duplicate entries (breaking their links)
    2. Search page modifications, and added a "how to clear data" page
    3. Fixed nearly 30 anatomical images by removing their ugly blue background (what had I been thinking when I created them!)

XII. Updates: February 2023

  1. Hip Osteoarthritis (rheum, Osteoarthritis)
    1. Added information regarding total hip arthroplasty
    2. Added links to Osteoarthritis and Knee Osteoarthritis Management for conservative measures
    3. Thanks to Dr. Wesam Khalfalla for feedback regarding this topic
  2. STI Postexposure Prophylaxis (id, std)
    1. Added Doxycycline 200 mg single dose within 3 days of unprotected intercourse
    2. Appears to reduce risk of Chlamydia, Gonorrhea, Syphilis
  3. Pediatric Toxicology (er, toxin)
    1. Extensive updates to more than 2 dozen specific ingestions
  4. Pain Sensation (neuro, exam)
    1. Updates to physiology and added a new diagram
  5. Carbapenem (id, pharm)
    1. Added extensive review
  6. Post-Tooth Extraction Bleeding (dental, procedure)
    1. Added
  7. Local Anesthetic (surgery, pharm)
    1. Updates, and added image
  8. Cholinergic Antagonist (neuro, pharm)
    1. Updates
  9. Biologic Agent (id, pharm)
    1. Updated precautions (pre-testing, Immunizations, perioperative use)
  10. Heart Failure with Reduced Ejection Fraction (cv, chf)
    1. Updates to optimizing triple therapy and quadruple therapy
  11. Pancreatitis (gi, Pancreas)
    1. Mild Pancreatitis does not require aggressive fluids (does not change outcomes and risks Fluid Overload)
  12. Surgical Antibiotic Prophylaxis (surgery, prevent)
    1. Updates
  13. Perioperative Anticoagulation (hemeonc, surgery)
    1. Updates
  14. Hepatorenal Syndrome (gi, renal)
    1. Added Terlipressin and marked Norepinephrine as overall preferred Vasopressor
  15. Cefepime (id, pharm)
    1. Added
  16. Gamma Aminobutyric Acid (neuro, anatomy)
    1. Added
  17. Opioid Analgesic (pharm, Analgesic)
    1. Updates
  18. Skin of Color (derm, exam)
    1. Updates to Skin of Color and the associated more common conditions
  19. Tonsillitis (ent, mouth)
    1. Updates to Tonsillitis and added Tonsillolith
  20. Polyarticular Arthritis (rheum, joint)
    1. Updates
  21. Temporomandibular Joint Disease (dental, jaw)
    1. Updates
  22. Hypokalemia (renal, Potassium)
    1. Updates
  23. Hyperkalemia (renal, Potassium)
    1. Updates
  24. Mononucleosis (id, virus)
    1. Updates
  25. Arsenic Poisoning (er, toxin)
    1. Updates
  26. Healthcare for Children in Foster Care (prevent, HME)
    1. Added
  27. Social Determinants of Health (pharm, nutrition)
    1. Added description and resources
  28. aVR ST Elevation with Diffuse ST Depression (cv, exam)
    1. Added causes
  29. Failure to Thrive in Dementia (pharm, neuro)
    1. Additional reasons NOT to use Feeding Tubes in Dementia
  30. Tendon Sheath Injection (rheum, procedure)
    1. Added
  31. Skin Ulcer (derm, exam)
    1. Updates
  32. Charcot Joint (rheum, neuro)
    1. Updates
  33. Obesity Medications (endo, pharm)
    1. GLP-1 Analogs appear very effective for weight loss
  34. Exercise in Diabetes Mellitus (endo, sports)
    1. Updates
  35. Antidepressant (psych, pharm)
    1. Extensive updates and additions to individual tricyclics, SSRI, SNRI and atypical Antidepressants

XIII. Updates: January 2023

  1. Small Caliber Chest Tube (lung, procedure)
    1. Updates regarding finding a safe entry site with POCUS in smaller air and fluid collections
  2. Supraventricular Tachycardia (cv, ekg)
    1. Troponin Is not needed (or recommended) for patients with SVT (unless specifically indicated for findings after sinus conversion)
  3. Medications in Lactation (ob, pharm)
    1. Extensive updates
  4. Anxiety Disorder (psych, anxiety)
    1. Extensive updates
  5. Hip Fracture (ortho, hip)
    1. Updates
  6. Health Care of the Homeless (prevent, hme)
    1. Updates
  7. Whole Blood Transfusion (hemeonc, pharm)
    1. Added as option in massive Traumatic Hemorrhage
  8. Chest Pain (cv, sx)
    1. Added differential diagnosis in children
  9. Small Bowel Obstruction (surgery, gi)
    1. Updates
  10. Septic Arthritis (rheum, id)
    1. Updates
  11. Hearing Aid Direct-To-Consumer (ent, pharm)
    1. Updates
  12. Lice (derm, Parasite)
    1. Updates
  13. Psoriasis (derm, hyperplasia)
    1. Updates to management
  14. Galactorrhea (gyn, sx)
    1. Updates to Galactorrhea, Hyperprolactinemia and Pituitary Adenoma
  15. CVA Thrombolysis (hemeonc, pharm)
    1. Tenecteplase (TNKase) has been used instead of Alteplase (t-PA) by some centers
    2. Initial studies have shown similar safety and efficacy for TNKase when compared with t-PA
    3. However, NOR-TEST 2 trial showed increased Intracranial Hemorrhage and lower efficacy with TNKase
  16. Sodium Fluoroacetate Poisoning (er, toxin)
    1. Added
  17. Acute Otitis Media (ent, ear)
    1. Updates
  18. Dix-Hallpike Maneuver (ent, exam)
    1. Updates
  19. Chronic Shoulder Dislocation (ortho, Shoulder)
    1. Added
  20. Antibiotic Overuse (id, pharm)
    1. Updates
  21. Rhinovirus (id, virus)
    1. Added
  22. Hypertension Reduction Goal (cv, htn)
    1. AAFP recommends BP <140/90
  23. Teen Pregnancy (ob, peds)
    1. Updates
  24. Opioid Use Disorder in Pregnancy (psych, ob)
    1. Added
  25. Stress Incontinence (urology, Bladder)
    1. Updates related to mesh surgery procedure complications
  26. Allergic Contact Dermatitis (ent, derm)
    1. Updates to signs, evaluation and management
  27. Proton Pump Inhibitors (renal, pharm)
    1. Added to Hypomagnesemia Causes
  28. Twist Score (urology, exam)
    1. Efficacy data in Testicular Torsion added
  29. Transition to Longterm Care (geri, prevent)
    1. Updates to approach
  30. Antenatal Screening (ob, lab)
    1. Placental Cell-Free DNA (Noninvasive Prenatal Testing or NIPT) is a screen for monogenic and subchromosomal genetic abnormalities (e.g. skeletal dysplasia, Sickle Cell Disease, Cystic Fibrosis)
    2. Associated with high False Positive Rates and ACOG does not recommended for general risk pregnancies
  31. Critical Illness (er, exam)
    1. Updates regarding radiology department transfers in Unstable Patients

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