Board Review

Relapsing-remitting multiple sclerosis
With abnormal brain MRI
⬇️
Start interferon beta or Glatiramer acetate
↙️ ↘️
Adequate response Inadequate response
⬇️ ⬇️
Continue Check JC virus
Therapy. Antibodies
↙️↘️
Negative Positive
⬇️ ⬇️
Start Start
Natalizmab Fingolimod

A 61-year-old man is evaluated for epigastric pain worsening over 7 months. The pain worsens with eating and is not relieved by antacids. The patient reports no melena, diarrhea, weight loss or constipation. medical history is unremarkable and he takes no medication.

On physical examination, vital signs are normal. Epigastric tenderness to palpation is noted. Other findings are normal.

Basic Blood work is unremarkable

What is the next step

- start PPI
- consult GI
- ureas breath test
- get abdominal ultrasound

treatment approach for constipation

FSOSS

1- Fibers or bulking agents (Psyllium and methycellulose)
2- Surfactants - (docusate sodium)
3- Osmotic laxatives ( lactulOse, mOgnesium hydroxide, pOlyethylene gylcOL)
4- Stimulant laxatives (senna)
5- Secretagogues or prosecretory agents (lubiprostine, linaclotide)

Transfusion medicine
wAshing Modification
Needed for

- h/o complement mediated Autoimmune hemolytic anemia
- IgA deficiency
- Allergic reaction
- h/o (A)Hives w transfusion despite using anti-histamine treatment

Remember the As

RCRI (revised cardiac risk index)

HH-DISC

High risk surgery
HF
Diabetes on insulin
IHD
Stroke
Cr>2

CLL, autoimmune hemolytic anemia, IgG, spherocytes

Calcium oxalate stones
Crohns
Malabsorption
Distal RTA (type 1)
Envelope or dumbbell shaped

Diabetic Pt with proteinuria started on lisinopril. Follow up Lab showed cr higher by 20% and ua is positive for RBCs

What would you do
- continue lisinopril and monitor
- get kidney biopsy
- nephrology consult