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

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

http://thischangedmypractice.com/

OSA - Dr. Pearce Wilcox

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