creatinine clearance) could have build-up of metformin that could lead to feared side effect of lactic acidosis (reason metformin often held among patients admitted to hospital) Key idea: Metformin is cleared by the kidneys and therefore patients with acute or chronic reduction in GFR (i.e.Middle-aged woman with increased BMI and strong family history of T2DM found to have laboratory evidence of diabetes (HgbA1c > 6.5%) with signs of renal disease who therefore would NOT be a candidate for Metformin.A 62-year-old woman comes to the physician because she is concerned about her risk for type 2… Spondylolisthesis –> Adolescent with back pain that worsens with spinal extensionģ.Ankylosing spondylitis –> Young patient with back pain worse in the morning that improves with use and imaging showing involvement of sacroiliac joints.Osteomyelitis/Epidural abscess (fever, IVDU, etc.) Malignancy (prostate, breast, lung, multiple myeloma, etc.) 3. Fracture (older woman, history of chronic steroid use, etc.) 2. Key idea: Back pain with point tenderness has a limited differential: 1.Post-menopausal older woman with chronic steroid use who presents with non-traumatic back pain found to have normal vitals with point tenderness over lumbar spine most concerning for compression fracture.A 67-year-old woman comes to the physician because of constant, severe, nonradiating low back… Reducing coffee and tobacco use should also reduce blood pressure, but weight loss is #1 strategy for anyone with BMI > 25Ģ.Key idea: Best interventions for reducing blood pressure in order from greatest effect to smallest effect: Weight loss (to BMI DASH diet > Increased exercise > Reduced alcohol intake.
An asymptomatic 42-year-old man with a 1-month history of essential hypertension comes for a follow-up…
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