Jimmy Stewart, MD Professor of Medicine and Pediatrics Division of General Internal Medicine and Hypertension Program Director, Med/Peds Program University of Mississippi Medical Center

Screening Vaccinations Prophylaxis Education

All adult ages yo 40+ or 10 years prior to relative FOBT, flex sig for “average risk” Colonoscopy - every 5-10 years for high risk

PSA - NOT recommended for routine screening Greatest sens in AA or high risk group

High Risk (CAD or equivalent) – statin LDL > 190 mg/dL – statin ASCVD risk > 7.5 % - statin

MMR* Oral Polio Nasal influenza Yellow fever Smallpox Typhoid BCG Varicella (including Zostavax)

HBV Influenza Pneumococcal Hib MMR/Td

 Asplenia  >65 yo every 5 years  Chronic disease (including DM)

Yearly >50 yo Healthcare workers Childcare workers Household contacts of above

>55 yo? History of zoster not important

Meningococcal - not against “B”, college freshmen Cholera - DOESN’T WORK

 Flouroquinolones  Azithromycin  Must take daily

Mild: 1-2 stools/day - loperamide Mod: 3 stools/day - single dose Abx Sev: 6 stoos/day - Abx x 3 days with loperamide

 Flouroquinolones  Azithromycin

 Chloroquine-resistant - Mefloquin (neuro SE’s)  Chloroquine  Others - doxy, primaquine, azithromycin

Gray - resistant; Blue - sensitive

 Rifampin  Cipro  Rocephin - pregnancy

 Smoking cessation  Firearm safety  Bladder Cancer  Folate supplementation  Osteoporosis  CVA

 Isopropyl (rubbing alcohol)  Methanol (wood alcohol)  Ethylene Glycol  Salicylates  Acetaminophen  Theophylline Lithium Tricyclics PCP Anticholinergics Cholinergics CO Cyanide Pb Insecticides

 CNS depression  Osmolal gap  Early lavage  Hemo/peritoneal dialysis

 Visual changes  AG met acidosis  Treat with ETOH, folate, dialysis, fomepizole

 Ca oxalate crystals  AG met acidosis  Treat with ETOH, bicarb, calcium, dialysis, fomepizole

Calcium Oxalate: “folded box”

 AG met acidosis  Classic presentation: AG with pH 7.4 and history  Treatment - lavage, alkalinization, hemodialysis, charcoal

 N - acetylcysteine  Early gastric emptying  Normogram

 Seizures  Treat with diazepam, lavage, charcoal, cathartic

 MS changes, Parkinsonian  DO NOT GIVE CHARCOAL  Lavage, electrolytes/fluids, hemodialysis

 Tachycardia, long QT, PR, QRS  Hemodialysis INEFFECTIVE  Alkalize  Lidocaine/phenytoin

 Agitation, seizures, dystonia, HTN  Give ammonium Cl to acidify the urine  Diazoxide for HTN

 “Red as a beet, dry as a bone, blind as a bat, mad as a hatter, and hot as a hare”  Supportive care  Physostigmine

 Scopolamine  Antihistamines  Antipsychotics  Antispasmotics  Cyclic antidepressants  Mydriatics

 “SLUDGE”  “DUMBELS”  Skin cleansing  Atropine  2-PAM for organophosphates

 CNS depression  mild-mod: 15-30%  mod-sev: >30%  Fatal: >50%  O2

 Almond breath, bright red venous blood  Amyl nitrate  3% Na nitrite  Sodium thiosulfate

 Autonomy  Beneficence  Nonmaleficence  Cultural differences  Confidentiality  Brain death - NO EEG REQUIRED!

 Clinical Risk  Functional Capacity  Risk of Surgery

 History  PE  ECG (men >40 yo, women >55 yo, CAD)

 Excellent: >7 METs  Moderate: 4-7 METs (angina walking >2 blocks)  Poor <4 METs (angina walking 1-2 blocks)

 Low - endoscopy, local biopsy, breast biopsy, vasectomy, cataract  Mod - CEA, intraperitoneal, intrathoracic, orthopedic, prostate, head and neck  High - emergencies, long procedures/fluid shifts, CVS (cross- clamping aorta or bypass

 Moderate risk with poor functional capacity  Moderate risk with good functional capacity and high risk surgery  High Risk - all

 Exercise stress treadmill  Dipyridamole thallium  Dobutamine stress echo

 Low risk patient goes directly to surgery without testing  Moderate risk patient with good functional capacity goes directly to nonvascular surgery  High risk patient need further workup

 Glaucoma  Retinal Detachment  Retinal Vascular Occlusion  Optic Neuritis  Vitreous Hemorrhage  Alkali/Trauma Iridocyclitis Keratoconjunctivitis Viral conjunctivitis Bacterial conjunctivitis Neisseria conjunctivitis Endophthalmitis

 Asian American with severe acute nausea, headache while in movie theater  Ocular emergency  Pupillary constriction

 Acute trauma to head/globe  Flashes/streaks of light, showers of black dots  Ocular emergency

 Sudden, PAINLESS BLINDNESS  Mostly embolic  Ocular emergency

 Ocular pain with eye movement, loss of vision  MS

 Sudden painless loss of vision  Must look for retinal detachment

 VA  Anterior chamber: hyphema, corneal laceration, subconjunctival hemorrhage, pupil distortion  Irrigation for alkali  Referral

 VA decreased  Pain  Photophobia  Pre-auricular adenopathy  Discharge

 Ocular pain, photophobia, ciliary flush  Emergent referral  Behcet’s  AK  IBD  JRA  Reiter’s Syndrome Sarcoid Syphillis TB Lyme disease

 Elderly, middle-age women  Graves disease  RA  Sarcoid

 Most common cause of red eye  Pre-auricular LAD

 Staph, strep, H. flu, Pseudomonas, Moraxella  Antibiotic treatment: Polytrim, gent, tobra, fluoroquinolones

 Hyperacute course  MUST TREAT WITH SYSTEMIC ABX!  3rd generation Cephalosporin IM/IV

 Eye pain with movement  Chemosis  Hypopyon  Fever  Eye discharge

 Alkali  Trauma  Orbital Cellulitis  Central retinal artery occlusion  Acute angle closure glaucoma  Optic nerve infarction in giant cell arteritis

 Penetrating injury  Endophthalmitis  Retinal detachment  Keratitis/keratoconjunctivitis

 Cental Retinal vein occlusion  Optic neuritis  Vitreous detachment/hemorrhage