A typical clinic day

Map Branches

• Prenatal care visit
  • First trimester visit
  • Wants to know what kind of risk she's at if she gets H1N1
    • More likely to get hospitalized (32/1000 vs. 7.6/1000
    • Of 45 deaths over 2 mo, 6 (13%) were in pregnant women
    • CDC recommends H1N1 vaccine
    • Recommends prompt antiviral Rx
• Child with an abscess
  • CA-MRSA abscess diagnosed
  • I&D performed
  • Do you need to Rx antibiotics?
    • Double blind RCT in ED (n=149)
    • 10 days TMP-SMZ vs. Placebo
    • New abscess formation higher at 2 wks but = at 3 mos
• Renovascular HTN
  • You've Dx'd AS-RAS
  • Do you recommend stenting?
    • n=140 w/ CrCl <80mL/min
    • 46 received stents vs. medical management
    • Only a 5% difference between those with >20% decline in CrCl over 2 yrs
    • Serious adverse effects occurred only in stent group
• Statin-related myalgias
  • Can't tolerate statins
  • Can I use anything else safely?
    • RCT 62 pts
    • 1800mg Red Yeast Rice vs. Placebo
    • At 24 wks 35mg/dL drop w/ RYR vs. 15mg/dL placebo
    • Caution: small study!
• Osteoporosis follow-up
  • Elderly woman begun on bisphosphonate
  • When do you get a follow-up BMD?
    • Mean hip BMD rose in 97.5% on alendronate at 3 yrs
    • Large variability exists in BMD w/in individual patients

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