Oral Antihypertensive Medications - Selection by Comorbidities Comorbidities: • Stable Angina, HFpEF, HFrEF, AFib, TAA/Marfan, Aortic Dissection • CKD, DM, ESRD, PKD • Pregnancy, Cluster Headache, Migraine, Opioid Withdrawal, PAD, Scleroderma, Essential Tremor • Supine HTN, BPH, Cognitive Impairment, Portal HTN/varices, Osteoporosis, Gout, Rapid-Acting Matthew Ho, MD PhD @MatthewHoMD #Oral #Antihypertensive #Medications #Hypertension #HTN #Comorbidities #pharmacology #table #management

Lactic Acidosis - Differential Diagnosis Framework Type A: Impaired O2 Delivery (DO2) • Decreased O2 Delivery: Hypotension & Hypovolemia, Trauma & burns, Cardiogenic & Septic Shock, Severe Anemia, Cardiac Arrest, Severe Hypoxemia, Regional Ischemia, Compartment Syndrome • Increased O2 Demand: Stress / Pain / Exercise, Fever, Hypothermia & Shivering, Seizures, Beta-Agonists, ↑ work of breathing, Localized soft-tissue infection, Mesenteric Ischemia, Microcirculatory dysfunction Type B: Impaired O2 Utilization (VO2) • Drugs/Toxins: - Propofol (PRIS), Valproic Acid, Biguanides (Metformin), Linezolid, Lactulose, HIV Antiretrovirals (esp. NRTIs), Acetaminophen, Ethanol, Methanol & Other toxic alcohols, Sodium Nitroprusside, Others (ie. Ricin, Strychnine, Niacin, Salicylates, Isoniazid) • Impaired Clearance: Systemic liver Failure, Renal failure, Mitochondrial dysfunction, Inborn Errors of Metabolism • Other: - Infections (ie. HIV, Malaria, Late Sepsis), Malignancy (Leukemia/Lymphoma), Diabetes Mellitus +/- DKA, Alcoholic lactic acidosis, Deficiencies (Thiamine & Biotin) Type D: Bacterial Overgrowth • Presents as AG acidosis with negative lactate. Difficult to diagnosis as it requires separate D-lactate testing • Seen in Short Bowel Syndrome, where decreased carbohydrate digestion leads to presence of additional sugars in the colon. • Bacteria ferment and convert these sugars into D-Lactate Excerpted from original infographic by Nick Mark MD @nickmmark #Lactic #Acidosis #Differential #Diagnosis #criticalcare #lactate

Chronic Obstructive Pulmonary Disease (COPD) • COPD Definition • Role of PFTs • COPD Classification and Evaluation (GOLD 2022) - Evaluate symptoms, risk factors and confirm post-bronchodilator FEV1/FVC < 0.7 - Airflow limitation assessment (determine GOLD Grade) - Symptom assessment (can use mMRC or CAT), Exacerbation risk in the last 12 months (# of exacerbations requiring antibiotics or steroids) - GOLD Group Assessment (ABCD) - Assess for co-morbidities • COPD Therapies - Bronchodilators (Beta-agonists, Antimuscarinics) - Anti-inflammatory therapies - Common Combination Therapies By @PulmPEEPs #Chronic #Obstructive #Pulmonary #Disease #COPD #diagnosis #management #GOLD2022 #treatment

COPD Exacerbations - Management • Identify Triggers • Assess Severity • Risk for Poor Outcomes • Initial Treatment: - Address Hypoxemia (Supplemental oxygen, NIPPV) - Systemic corticosteroids - Dual bronchodilators - Antibiotic Therapy (Azithromycin) By @PulmPEEPs #COPD #Exacerbation #Management #treatment #pulmonary

Pulmonary Renal Syndrome Definition: Diffuse alveolar hemorrhage + Glomerulonephritis Presentation (Pulmonary and renal manifestations can occur weeks apart): Cough, Dyspnea, Fever, Hematuria, Hemoptysis, Peripheral edema, Disease-specific symptomatology Differential Diagnosis for Pulmonary Renal Syndromes: • Pauci-Immune: - ANCA-positive vasculitis (Eosinophilic granulomatosis with polyangiitis, Granulomatosis with polyangiitis, Microscopic polyangiitis) - ANCA-negative vasculitis (IgA-associated vasculitis, Behcet disease, Cryoglobulinemia) • Immune Complex: Systemic lupus erythematosus, Rheumatoid arthritis, Systemic sclerosis • Anti-Glomerular Basement Membrane: Goodpasture's Disease • Other: Drugs (hydralazine, propylthiouracil, allopurinol), Infection, Alport Syndrome Investigations • Labs: CBC, cr, ESR, CRP • Urinalysis (proteinuria, dysmorphic RBCs) • Disease-specific testing: anti-ANCA ab, anti-GBM ab, ANA, C3, C4, anti-CCP • CXR (diffuse infiltrates) → high resolution chest CT • Bronchoscopy with serial BAL → confirm DAH, rule out infection, biopsy By Tess Litchman, MD @TessLitchman via @PulmPEEPs #Pulmonary #Renal #Syndrome #differential #diagnosis #nephrology

Mediastinal Widening - Differential Diagnosis • Vascular: Aortic dissection, Aortic anourysm, Enlarged pulmonary arteries, Venous or arterial great vessel congential abnormality (ex: duplicated SVC) • Pulmonary: Upper or middle lobe collapse, Atelectasis, Nodule / mass • Masses: Anterior mediastinal (Thymoma, Thyroid, Lymphoma, Germ cell tumor), Middle mediastinal, Posterior mediastinal • Lymphadenopathy • Pericardial: Pneumomediastinum, Pericardial effusion • CXR rotation By @PulmPEEPs #Mediastinal #Widening #Differential #Diagnosis #pulmonary #radiology

Common Childhood Exanthems - Differential Diagnosis 1) Rubeola (Measles) - Measles morbillivirus (MeV) 2) Scarlet Fever - Streptococcus pyogenes 3) Rubella (German measles) - Rubella Virus 4) Staphylococcal Scalded Skin Syndrome - Staphylococcus aureus 5) Erythema infectiosum - Parvovirus B19 6) Exanthem subitum (Roseola infantum) - Human Herpes Virus 6B or 7 By @TheIDtrivia #Childhood #Exanthems #Differential #Diagnosis #pediatrics

Adverse Effects of Antipsychotic Medications - Comparison Table First Generation: chlopromazine, haloperidol, fluphenazine Second Generation: aripirazole, asenapine, brexpiprazole, lurasidone, olanzapine, paliperidone, pimavanserin, quetiapine, risperidone, ziprasidone, clozapine Side Effects: EPS/TD, Dyslipidemia, Weight Gain/T2DM, Elevated prolactin, Anticholinergic effects, Orthostatic hypotension, QTC prolongation #Atypical #Antipsychotics #SideEffects #Adverse #Psychiatry #Pharmacology #Profiles #Comparison #Table #DecisionAid

Pharmacology of Antipsychotic Drugs for Bipolar Disorder • PHENOTHIAZINES: Chlorpromazine, Fluphenazine, Thioridazine • THIOXANTHENE: Thiothixene • BUTYROPHENONE: Haloperidol • SECOND-GENERATION: Aripiprazole, Brexpiprazole, Cariprazine, Clozapine, Lurasidone, Olanzapine, Quetiapine, Risperidone, Ziprasidone • LITHIUM • OTHER AGENTS FOR BIPOLAR DISORDER: Carbamazepine, Lamotrigine, Valproic acid #Antipsychotic #Drugs #Bipolar #Disorder #Pharmacology #medications

Suspected ACS - OMI vs STEMI - Differential Algorithm The name STEMI cognitively inspires EPs to fail at the reperfusion decision because it makes clinicians believe that the ST segment is the only ECG finding predictive of occlusion EMN @EMNews #ACS #OMI #STEMI #Differential #Algorithm #cardiology #occlusionMI #myocardial #infarction #diagnosis #coronary #syndrome