II. Updates: March 2023

  1. Genital Herpes in Pregnancy (id, ob)
    1. Thank you to Dr. Manuel Tu for correcting the Acyclovir prophylaxis dosing to 400 mg orally tid
    2. Other updates including adding Valtrex as an additional management option
  2. Skin Conditions of Pregnancy (derm, ob)
    1. Extensive updates
  3. Monkeypox (id, virus)
    1. Extensive updates
  4. Myocardial Dysfunction after Cardiac Arrest (er, exam)
    1. Updates
  5. CHF in Children (cv, peds)
    1. Updates
  6. Thrombotic Thrombocytopenic Purpura (hemeonc, Platelets)
    1. Updates
  7. Denusamab (rheum, med)
    1. Added, along with Hypocalcemia risk
  8. Group A Streptococcus (id, Bacteria)
    1. Updated regarding severe invasive disease
  9. Genitourinary Syndrome of Menopause (gyn, vagina)
    1. Updates
  10. Helicobacter Pylori (gi, id, pud)
    1. Extensive updates
  11. Kaposi Sarcoma (hemeonc, hiv)
    1. Updates
  12. Antipsychotic (psych, pharm)
    1. Added Asenapine, Brexpiprazole, Cariprazine, Lurasidone, Pimavanserin, Iloperidone, Paliperidone, Chlorpromazine, Fluphenazine
    2. Updated Aripiprazole, Ziprasidone, Clozapine, Olanzapine, Quetiapine, Risperidone, Haloperidol, Perphenazine, Molindone, Loxapine
  13. Depression Medical Management (psych, Depression)
    1. Extensive updates
  14. Inflammatory Bowel Disease (gi, ibd)
    1. Updates including Crohn Disease and Ulcerative Colitis
  15. Diverticulitis (gi, bowel)
    1. Updates
  16. Neonatal Vomiting (gi, peds)
    1. Updates
  17. Toxic Megacolon (surgery, gi)
    1. Added
  18. Potassium Chlorate (er, toxin)
    1. Added
  19. Otitis Externa (ent, ear)
    1. Updates
  20. Lever Test (ortho, exam)
    1. Added highly sensitive test for ACL Rupture (and an image)
  21. Nursemaid's Elbow (ortho, elbow)
    1. Updates
  22. Myofacial Pain Syndrome (rheum, myofascial)
    1. Updates
  23. Inducing Lactation in Adoptive Mothers (ob, Lactation)
    1. Added
  24. Lactogenesis (gyn, anatomy, Breast)
    1. Updated
  25. Gastrointestinal Opioid Antagonist (gi, pharm)
    1. Updated efficacy
  26. Atopic Dermatitis (derm, dry)
    1. Medium potency steroids are as effective as high potency steroids in Eczema management
  27. Religious Fasting During Ramadan (pharm, nutrition)
    1. Added
  28. End-Of-Life Care (hemeonc, psych)
    1. Updates
  29. Bug Fixes (manage, computer)
    1. Fixed dozens of duplicate entries (breaking their links)
    2. Search page modifications, and added a "how to clear data" page
    3. Fixed nearly 30 anatomical images by removing their ugly blue background (what had I been thinking when I created them!)

III. Indications

  1. Inducing Lactation in women who have not given birth (e.g. adoptive mother)

IV. Updates: February 2023

  1. Hip Osteoarthritis (rheum, Osteoarthritis)
    1. Added information regarding total hip arthroplasty
    2. Added links to Osteoarthritis and Knee Osteoarthritis Management for conservative measures
    3. Thanks to Dr. Wesam Khalfalla for feedback regarding this topic
  2. STI Postexposure Prophylaxis (id, std)
    1. Added Doxycycline 200 mg single dose within 3 days of unprotected intercourse
    2. Appears to reduce risk of Chlamydia, Gonorrhea, Syphilis
  3. Pediatric Toxicology (er, toxin)
    1. Extensive updates to more than 2 dozen specific ingestions
  4. Pain Sensation (neuro, exam)
    1. Updates to physiology and added a new diagram
  5. Carbapenem (id, pharm)
    1. Added extensive review
  6. Post-Tooth Extraction Bleeding (dental, procedure)
    1. Added
  7. Local Anesthetic (surgery, pharm)
    1. Updates, and added image
  8. Cholinergic Antagonist (neuro, pharm)
    1. Updates
  9. Biologic Agent (id, pharm)
    1. Updated precautions (pre-testing, Immunizations, perioperative use)
  10. Heart Failure with Reduced Ejection Fraction (cv, chf)
    1. Updates to optimizing triple therapy and quadruple therapy
  11. Pancreatitis (gi, Pancreas)
    1. Mild Pancreatitis does not require aggressive fluids (does not change outcomes and risks Fluid Overload)
  12. Surgical Antibiotic Prophylaxis (surgery, prevent)
    1. Updates
  13. Perioperative Anticoagulation (hemeonc, surgery)
    1. Updates
  14. Hepatorenal Syndrome (gi, renal)
    1. Added Terlipressin and marked Norepinephrine as overall preferred Vasopressor
  15. Cefepime (id, pharm)
    1. Added
  16. Gamma Aminobutyric Acid (neuro, anatomy)
    1. Added
  17. Opioid Analgesic (pharm, Analgesic)
    1. Updates
  18. Skin of Color (derm, exam)
    1. Updates to Skin of Color and the associated more common conditions
  19. Tonsillitis (ent, mouth)
    1. Updates to Tonsillitis and added Tonsillolith
  20. Polyarticular Arthritis (rheum, joint)
    1. Updates
  21. Temporomandibular Joint Disease (dental, jaw)
    1. Updates
  22. Hypokalemia (renal, Potassium)
    1. Updates
  23. Hyperkalemia (renal, Potassium)
    1. Updates
  24. Mononucleosis (id, virus)
    1. Updates
  25. Arsenic Poisoning (er, toxin)
    1. Updates
  26. Healthcare for Children in Foster Care (prevent, HME)
    1. Added
  27. Social Determinants of Health (pharm, nutrition)
    1. Added description and resources
  28. aVR ST Elevation with Diffuse ST Depression (cv, exam)
    1. Added causes
  29. Failure to Thrive in Dementia (pharm, neuro)
    1. Additional reasons NOT to use Feeding Tubes in Dementia
  30. Tendon Sheath Injection (rheum, procedure)
    1. Added
  31. Skin Ulcer (derm, exam)
    1. Updates
  32. Charcot Joint (rheum, neuro)
    1. Updates
  33. Obesity Medications (endo, pharm)
    1. GLP-1 Analogs appear very effective for weight loss
  34. Exercise in Diabetes Mellitus (endo, sports)
    1. Updates
  35. Antidepressant (psych, pharm)
    1. Extensive updates and additions to individual tricyclics, SSRI, SNRI and atypical Antidepressants

V. Updates: January 2023

  1. Small Caliber Chest Tube (lung, procedure)
    1. Updates regarding finding a safe entry site with POCUS in smaller air and fluid collections
  2. Supraventricular Tachycardia (cv, ekg)
    1. Troponin Is not needed (or recommended) for patients with SVT (unless specifically indicated for findings after sinus conversion)
  3. Medications in Lactation (ob, pharm)
    1. Extensive updates
  4. Anxiety Disorder (psych, anxiety)
    1. Extensive updates
  5. Hip Fracture (ortho, hip)
    1. Updates
  6. Health Care of the Homeless (prevent, hme)
    1. Updates
  7. Whole Blood Transfusion (hemeonc, pharm)
    1. Added as option in massive Traumatic Hemorrhage
  8. Chest Pain (cv, sx)
    1. Added differential diagnosis in children
  9. Small Bowel Obstruction (surgery, gi)
    1. Updates
  10. Septic Arthritis (rheum, id)
    1. Updates
  11. Hearing Aid Direct-To-Consumer (ent, pharm)
    1. Updates
  12. Lice (derm, Parasite)
    1. Updates
  13. Psoriasis (derm, hyperplasia)
    1. Updates to management
  14. Galactorrhea (gyn, sx)
    1. Updates to Galactorrhea, Hyperprolactinemia and Pituitary Adenoma
  15. CVA Thrombolysis (hemeonc, pharm)
    1. Tenecteplase (TNKase) has been used instead of Alteplase (t-PA) by some centers
    2. Initial studies have shown similar safety and efficacy for TNKase when compared with t-PA
    3. However, NOR-TEST 2 trial showed increased Intracranial Hemorrhage and lower efficacy with TNKase
  16. Sodium Fluoroacetate Poisoning (er, toxin)
    1. Added
  17. Acute Otitis Media (ent, ear)
    1. Updates
  18. Dix-Hallpike Maneuver (ent, exam)
    1. Updates
  19. Chronic Shoulder Dislocation (ortho, Shoulder)
    1. Added
  20. Antibiotic Overuse (id, pharm)
    1. Updates
  21. Rhinovirus (id, virus)
    1. Added
  22. Hypertension Reduction Goal (cv, htn)
    1. AAFP recommends BP <140/90
  23. Teen Pregnancy (ob, peds)
    1. Updates
  24. Opioid Use Disorder in Pregnancy (psych, ob)
    1. Added
  25. Stress Incontinence (urology, Bladder)
    1. Updates related to mesh surgery procedure complications
  26. Allergic Contact Dermatitis (ent, derm)
    1. Updates to signs, evaluation and management
  27. Proton Pump Inhibitors (renal, pharm)
    1. Added to Hypomagnesemia Causes
  28. Twist Score (urology, exam)
    1. Efficacy data in Testicular Torsion added
  29. Transition to Longterm Care (geri, prevent)
    1. Updates to approach
  30. Antenatal Screening (ob, lab)
    1. Placental Cell-Free DNA (Noninvasive Prenatal Testing or NIPT) is a screen for monogenic and subchromosomal genetic abnormalities (e.g. skeletal dysplasia, Sickle Cell Disease, Cystic Fibrosis)
    2. Associated with high False Positive Rates and ACOG does not recommended for general risk pregnancies
  31. Critical Illness (er, exam)
    1. Updates regarding radiology department transfers in Unstable Patients

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