Centor criteria

Addison’s disease
PCOS
Patient daily activity restrictions if they have seizure
Ketoconazole adverse effects, dosing for tinea
ALLHAT trial
Low-dose CT scan benefits+harms of screening
PCOS diagnostic criteria
Types of urinary incontinence in women
Arterial insufficiency signs
Sciatica management, ddx to consider
S4 heart sound
Gout etiology
Indications for holter monitor
Tick bite granuloma
Asthma types (i.e. mild, moderate, persistent)
Asthma therapy for mild, intermittent asthma
GINA Stepwise management of asthma
Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA)
update | npj Primary Care Respiratory Medicine (nature.com)
Need Social Work Resources Paper, Check Inbox
Alcohol as contraindication for menopausal hormone therapy?
Oct 19
Subclinical hypothyroidism
Tarsal tunnel syndrome
How osteoarthritis present in feet
Oct 23
Common cold prognosis and time course
AC joint separation, diagnosis and management, reduction instructions
Hydroceles
Migraine abortive and prophylactic therapy options
Oct 30
Renal protection meds
Spirometry interpretation (asthma)
Nov 6
Choosing wisely: routine labs for healthy males <35Y
Counseling on checking weights for CHF patients
Telemonitoring in Patients with Heart Failure | NEJM
Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US
Preventive Services Task Force Recommendation Statement | Cardiology | JAMA |
JAMA Network
 Weight monitoring in patients with severe heart failure (WISH). A randomized controlled
trial - Lyngå - 2012 - European Journal of Heart Failure - Wiley Online Library
Can you still have gout with a normal uric acid level?
Are serum uric acid levels always elevated in acute gout? | MDedge Family Medicine
Serum Urate During Acute Gout | The Journal of Rheumatology (jrheum.org)
1. Serum urate is often within the normal range during acute gout
2. Increased urinary excretion of uric acid, estimated by percentage change in fractional
excretion of uric acid, during acute gout significantly correlated with CRP levels during
an attack.
3.
Gout flair prophylaxis?
How do nasal polyps cause rhinorrhea and allergies?
Signs of bacterial sinusitis

Rhinosinusitis, bacterial vs viral. When to initiate antibiotics

Hypothyroidism and chronic kidney disease
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094898/
Kidney disease and thyroid dysfunction: the chicken or egg problem | SpringerLink
Why does choosing wisely recommend against imaging for asymptomatic carotid bruit
Transient pustular melanosis
How is T3 hormone activating, makes patients feel better
Weight loss by exercise alone, useless
What affects thyroid hormone absorption
Four criteria for choosing SGLT2/GLP1 on ADA chart
● In adults with type 2 diabetes and established/high risk of atherosclerotic cardiovascular
disease (ASCVD), heart failure (HF), and/or chronic kidney disease (CKD), the treatment
regimen should include agents that reduce cardiorenal
● The glucose-lowering treatment regimen should consider approaches that support
weight management goals, with very high efficacy for weight loss seen with semaglutide
and tirzepatide
● For people with type 2 diabetes and established ASCVD or indicators of high ASCVD
risk, HF, or CKD, an SGLT2 inhibitor and/or GLP-1 RA with demonstrated CVD benefit is
recommended as part of the glucose-lowering regimen independent of A1C,
independent of metformin use and in consideration of person-specific factors
● For people without established ASCVD, indicators of high ASCVD risk, HF, or CKD,
medication choice is guided by efficacy in support of individualized glycemic and weight
management goals, avoidance of side effects (particularly hypoglycemia and weight
gain), cost/access, and individual preferences
● Emerging data suggest that use of both classes of drugs will provide additional
cardiovascular and kidney outcomes benefit; thus, combination therapy with an SGLT2
inhibitor and a GLP-1 RA may be considered to provide the complementary outcomes
benefits associated with these classes of medication
● SGLT2 Inhibitors vs GLP-1 Agonists: A Cardiologist and an Endocrinologist …
● UofL Medicine Grand Rounds: Dr. Vanita Aroda
SGLT2 mechanism of action
● Sodium-glucose co-transporter 2 (SGLT2) inhibitors bind and inhibit SGLT2, the
transporter responsible for reabsorbing the majority of glucose filtered by the tubular
lumen in the kidney. SGLT2 is expressed in the proximal renal tubules. Inhibiting SGLT2
causes a decrease in filtered glucose reabsorption and lowers the renal threshold for
glucose (RTG), thereby increasing urinary glucose excretion and improving blood
glucose control. These glucose-lowering effects are insulin-independent.
● Through inhibition of glucose and sodium reabsorption, SGLT2 inhibitors exert osmotic
diuretic and natriuretic effects reducing both systolic and diastolic blood pressure.
Though the exact mechanism for the beneficial cardiorenal effects seen in clinical
studies of SGLT2 inhibitor therapy is not fully known, it is believed to be related to
glycosuria and natriuresis; these effects lead to uricosuria and reduction in plasma uric
acid, and a reduction in plasma volume, lowering of cardiac preload, and reduced arterial
pressure and stiffness possibly resulting in afterload reduction
● SGLT2 Inhibitors Explained in 3 Minutes
How to counsel parents on diluting formula to go down on infant weight gain
Management of hemorrhoids
Is bronchitis the same as COPD
Hypothyroidism and chronic kidney disease
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094898/
Kidney disease and thyroid dysfunction: the chicken or egg problem | SpringerLink
Why does choosing wisely recommend against imaging for asymptomatic carotid bruit
Stasis dermatitis, venous ulcer disease (presentation, physical exam findings)
Pulse ox limitations
Picky eaters in infants; how to manage, how to counsel parents
Complex regional pain syndrome; sympathetic
Nexplanon; mechanism of action; how long can it be in; how does it affect menstruation
Pap smear, Purpose
Morton neuroma; pathophysiology, treatment
ORIGINS trial
ACCORD trial
GLP-1 mechanism of action
SGLT-2 mechanism of action
Fasting blood glucose and postprandial blood glucose
Doxepin MOA, adverse effects
Silenaor MOA
Vascepa, mineral oil and cardiac risk. PROVE IT trial
Who should get screened for breast cancer?
Metformin, hypoglycemia concern
Ambulatory blood pressure monitoring
 Ambulatory Blood Pressure Monitoring in the Evaluation and Management of Hype…
2018: Out-of-Office/Home Blood Pressure Monitoring
Optimization of nocturnal blood pressure assessment and treatment
Automated Ambulatory Blood Pressure Monitoring: Clinical Utility in the Family Practice
Setting | AAFP
How partner smoking status affect smoking cessation chances
Children and smoking cessation for parents, pt was Koda?
Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
Hearing difficulty and dementia
Shoulder injection, landmarks, where are you injecting
Diagnostic and Therapeutic Injection of the Shoulder Region | AAFP
Myocardial perfusion scintigraphy, indications. Does it have a role in afib?
Utility of POC A1c vs serum
Primary aldosteronism, diagnosis and management
Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An
Endocrine Society Clinical Practice Guideline | The Journal of Clinical Endocrinology &
Metabolism | Oxford Academic
Grand Rounds 2023.12.6 (youtube.com)
Pseudohypoglycemia patients experience from pts taking insulin; homeostasis from
sugar setpoint
Vitamin D and fatigue?
Dietary Management of Cholesterol
https://www.uptodate.com/contents/lipid-management-with-diet-or-dietary-supplements?search=
lowering%20cholesterol%20diet&source=search_result&selectedTitle=1~150&usage_type=defa
ult&display_rank=1
https://www.uptodate.com/contents/lipid-management-with-diet-or-dietary-supplements?search=
lowering+cholesterol+diet&source=search_result&selectedTitle=1%7E150&usage_type=default
&display_rank=1
For patients with dyslipidemia, whether or not they are on concurrent
lipid-lowering pharmacologic therapy, we encourage adherence with one of the
following general dietary patterns known to improve serum lipids:
○ Mediterranean diet
○ Dietary Approaches to Stop Hypertension (DASH) diet
○ Vegetarian (or other meat restricted) diet
○ Low-carbohydrate diet
○ Avoidance of trans fats
Prior to recommending a diet or a specific dietary pattern, we evaluate an
individual's comorbidities, dietary preferences, and lipid-lowering requirements. In
particular, we consider the specific circulating lipid fractions that are elevated (eg,
LDL cholesterol and/or triglycerides) or reduced (eg, high-density lipoprotein
[HDL] cholesterol). As examples:
○ For individuals with elevated LDL cholesterol, we advise a reduction in
saturated fat and total caloric intake.
 ○ For those with isolated hypertriglyceridemia, we advise a
low-carbohydrate diet with a reduced total caloric intake.
○ For patients who are overweight, with elevated triglycerides and/or low
HDL cholesterol, and for patients with pre-diabetes and fatty liver disease,
we typically advise following a Mediterranean diet.
Mediterranean diet — There is no single Mediterranean diet, but such diets are
typically high in fruits, vegetables, whole grains, beans, nuts, and seeds and
include olive oil as an important source of fat; there are typically low to moderate
amounts of fish, poultry, and dairy products, and there is little red meat
DASH diet — The Dietary Approaches to Stop Hypertension (DASH) diet is rich
in fruits and vegetables, high in fiber, moderate in low- or non-fat dairy products,
low in animal protein, and low in saturated fat and contains many plant sources of
protein including legumes and nuts
Adherence to a Mediterranean Diet and Prediction of Incident Stroke
○ The traditional Mediterranean diet (MeD) is a dietary pattern
characterized by high consumption of plant foods, high intake of olive oil
as principal source of monounsaturated fat, low intake of saturated fat
with limited consumption of meat and dairy products, and moderate intake
of fish and alcohol
Mediterranean Diet Score, Dietary Patterns, and Risk of Sudden Cardiac Death
in the REGARDS Study | Journal of the American Heart Association
Impact of the level of adherence to the Mediterranean Diet on blood pressure: A
systematic review and meta-analysis of observational studies - ScienceDirect
The MD is characterized by an increased consumption of unprocessed
plant-based food components including vegetables, fruit, grains, legumes, nuts
and seeds, with olive oil constituting the main source of fat, moderate amounts of
alcohol, more specifically wine, and low to moderate intake of diary and red meat
Mediterranean Diet and Obesity-related Disorders: What is the Evidence? - PMC
Primary Prevention of Cardiovascular Disease with a Mediterranean Diet
Supplemented with Extra-Virgin Olive Oil or Nuts | NEJM
○ PREDIMED Study Retraction and Republication | The Nutrition Source |
Harvard T.H. Chan School of Public Health
○ http://dresselstyn.com/spanish_study.htm
Primary Prevention of Cardiovascular Disease with a Mediterranean Diet | NEJM
The Mediterranean Diet And Cardioprotection: Historical Overview And Current
Research - PMC
3.09.23 Grand Rounds: Treatment of Lipids in 2023: Where are we now an…
SSRIs and neuropathic pain
Multimodal pain regimens
Glycemic targets for elderly with DM2
○ Diabetes Management in the Elderly - PMC (nih.gov)
What dose of SNRI is effective for neuropathic pain
 Effectiveness of SNRI vs TCAs in treating sciatica pain
○ Efficacy and safety of antidepressants for the treatment of back pain and
osteoarthritis: systematic review and meta-analysis
○ A Look at Commonly Utilized Serotonin Noradrenaline Reuptake
Inhibitors (SNRIs) in Chronic Pain - PMC
○ Are Antidepressants Effective in the Treatment of Back Pain and
Osteoarthritis?
● Dermatologic description of rashes
● What is first-line for T2DM?
● What to prescribe for T2DM for renal protection?
● Dr. Wade Thompson: Statin deprescribing for older adults
● benzo.org.uk : Benzodiazepines: How They Work & How to Withdraw, Prof C H Ashton
DM, FRCP, 2002
● Counseling patients on positive STI results
● Counseling on primary prevention of STI
○ Sexually Transmitted Infections Treatment Guidelines, 2021 (cdc.gov)
● Obesity and GLP1
○ Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes | NEJM
■ Semaglutide was associated with decreases in body weight and waist
circumference, findings consistent with the known metabolic effects of this
class of medications.
■ Mechanisms of cardiovascular risk reduction with semaglutide may
include those related to physiological benefits from the reduction of
excess abnormal body fat and actions of semaglutide other than weight
loss. Weight loss across a spectrum of elevated BMIs produces not only
improvements in glucose levels and the traditional cardiovascular
intermediate risk factors28 but also reductions in ectopic adipose tissue
depots that may contribute to atherosclerosis and myocardial dysfunction
■ An important limitation of this trial is that we included only patients with
preexisting cardiovascular disease. The effects of semaglutide on primary
prevention of cardiovascular events in persons with overweight or obesity
but without previous atherosclerotic disease were not studied.
■ In comparison with placebo, participants randomized to semaglutide had
greater weight loss, greater reductions in Hgb A1c, BP, CRP, and
atherogenic lipid particles. Semaglutide had lower risk of severe adverse
events than placebo (33% vs 36%), but had a higher rate of
discontinuation for adverse vents than placebo (17% vs 8%), which was
most commonly from GI disorders
○ SELECTing Treatments for Cardiovascular Disease — Obesity in the Spotlight |
NEJM
■ After approximately 40 months of follow-up in the SELECT trial,
semaglutide resulted in a 20% reduction in the risk of a composite of
death from cardiovascular causes, nonfatal myocardial infarction, or
 nonfatal stroke, with consistent trends seen for each component of the
composite outcome as well as for death from any cause
■ On average, semaglutide treatment resulted in a substantial 9.4%
reduction in body weight
○ Semaglutide and Cardiovascular Outcomes (Correspondence)| NEJM
■ Since cardiovascular1 and metabolic2 benefits have been observed with
lower semaglutide doses and the risk of treatment discontinuation
increases at higher doses, it would be clinically relevant if the trial
provided information regarding the cardiovascular effects of semaglutide
at weekly doses of 1.7 mg or less.
■ it remains unclear whether the cardiovascular risk reduction is attributable
to weight loss or stems from the pharmacodynamics of semaglutide.
■ However, the authors did not provide data on the weight-loss percentages
for the semaglutide group that had a primary cardiovascular event.
Comparing the BMI of patients in the semaglutide group who had a
primary cardiovascular event with those who did not could offer useful
insights. If weight loss in itself is responsible for the reduction in
cardiovascular risk, that would have great implications for patients and
their health insurers, because the use of semaglutide would then not be
imperative in order to lower cardiovascular risk.
■ In the subgroup analyses of the primary cardiovascular efficacy outcome
(Fig. S5 in the Supplementary Appendix of the article), the data suggest
an interaction between BMI and the treatment effect of semaglutide.
Patients who had a BMI of less than 35 had a significant reduction in the
risk of cardiovascular events. Conversely, patients with a BMI of 35 or
greater did not have the same treatment effect. Could the authors
comment on whether these subgroup data suggest a window of
intervention with semaglutide to maximize its cardiovascular benefit in
patients with established cardiovascular disease and obesity?
Alternatively, are further trials warranted involving patients with higher
BMIs to evaluate the effect of semaglutide in that group?
○ Once-Weekly Semaglutide in Adults with Overweight or Obesity | NEJM
■ In this trial, we found that adults with obesity (or overweight with one or
more weight-related coexisting conditions) and without diabetes had a
mean weight loss of 14.9% from baseline with semaglutide as an adjunct
to lifestyle intervention
■ Moreover, 86% of participants who received semaglutide, as compared
with 32% of those who received placebo, lost 5% or more of baseline
body weight, a widely used criterion of clinically meaningful response
● Why is losing >5% of baseline body weight a criterion of clinically
meaningful response?
■ Weight loss with semaglutide stems from a reduction in energy intake
owing to decreased appetite, which is thought to result from direct and
indirect effects on the brain.22-25 Weight loss with semaglutide was
 accompanied by greater improvements than placebo with respect to
cardiometabolic risk factors, including reductions in waist circumference,
blood pressure, glycated hemoglobin levels, and lipid levels; a greater
decrease from baseline in C-reactive protein, a marker of inflammation;
and a greater proportion of participants with normoglycemia
■
○ https://www.nejm.org/doi/full/10.1056/NEJMoa2306963
○ Once-Weekly Semaglutide in Adolescents with Obesity | NEJM
○ Tirzepatide Once Weekly for the Treatment of Obesity | NEJM
○ Shifting Tides Offer New Hope For Obesity | NEJM
○ Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and
Obesity | NEJM
○ Heart Failure with Preserved Ejection Fraction — A Metabolic Disease? | NEJM
○ Semaglutide and Heart Failure with Preserved Ejection Fraction and Obesity |
NEJM
○ Once-Weekly Semaglutide in Adults with Overweight or Obesity | NEJM
○ Effects of once-weekly semaglutide on appetite, energy intake, control of eating,
food preference and body weight in subjects with obesity
○
○ Navigating GLP-1 agonists | 17 January 2024
○ SELECT Trial and Implications for Population Health
○ GLP-1 RAs in Non-diabetic Obesity - SELECT - Dr. Michael Lincoff (Clevel…
○ Role of GLP-1 Receptor Agonists for Weight Loss
○ The Increasing Importance of GLP-1–Based Therapies for Personalized O…
○ Targeting GIP and GLP-1 to Individualize Treatment in Patients With T2DM…
● GLP1 and diabetes
○ https://www.nejm.org/doi/full/10.1056/NEJMoa1607141
● Clinical vs statistical significance
○ Statistical significance or clinical significance? A researcher's dilemma for
appropriate interpretation of research results - PMC (nih.gov)
○ Common pitfalls in statistical analysis: Clinical versus statistical significance -
PMC (nih.gov)
● Impaired glucose tolerance
○ Lab 19: Glucose Tolerance Test
● Reversal of prediabetes
○ Regression from prediabetes to normal glucose regulation: State of the science -
Anthony Sallar, Samuel Dagogo-Jack, 2020 (sagepub.com)
● Liver metabolism of fatty acids