3/ What are your ULT options? Check out the awesome slide below.
Takeaways:
💊Start with allopurinol! It will give you the biggest bang for your buck
💊Your target UA level is 6⃣- titrate q2-4 weeks
💊Start prophylactic therapy at the same time (NSAID, colchicine, pred)
4/Quick pause for a question to jog a memory from your USMLE step 1 days.
What antihypertensive medication has a uricosuric effect?
5/ ANS: Losartan!
Key things to check *before* starting allopurinol:
🧪GFR
🧪HLA–B*58:01 in individuals of Southeast-Asian descent & and African-American individuals!
This allele is strongly associated with severe cutaneous adverse reactions (SCAR) w allopurinol like SJS!
6/ Here is a summary slide with take-home points!
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1/ 34 y/o F with new AML dx on chemo (7+3) ANC 200. Counts are expected to continue to drop & not get better for at least another ~10d. Has been febrile 🌡️🔥 & on cefepime 2g q8 for the past 5 days💊💉. What do you do next?
1/36 y/o F hx of anxiety p/w a 2nd episode of transient chest pain w emotional stress & her admission EKG shows 4 mm ST elevations in leads V1-V3. Her 1st troponins check was high. She is currently chest-pain free & vitals are normal.
3/ You look up and notice the STEMI pathway chart conveniently plastered above your workstation‼️
You recognize the patient's presentation is consistent with ACS and her ST elevations meet criteria for STEMI---> you appropriately escalate and decide to call "code STEMI" 🚨📞
2/ First, the spleen is a complex, beautiful & underrated organ. There, we said it. 🤷
It’s so great that 15% of people have an extra accessory spleen
The spleen has 3 general components: A marginal zone & 2 pulps.
3/ ↔️Marginal Zone: Free-flowing transit space for immune cells, where antigens are captured by dendritic cells and B cells (i.e. as APCs) prior to migration to white pulp.
⚪️White Pulp: Physically exclusive lymphoid tissue where T and B cells mature 👶👧👩👵