Brilliant Board Review & CME

Send a text 🧠 Context: Rising rates of carbapenem-resistant gram-negatives , especially those producing MBLs like NDM, VIM. 💊 Drug Combo: Aztreonam + Avibactam = a lifeline for metallo-beta-lactamase (MBL) producers . FDA-approved for: Complicated intra-abdominal infections (with metronidazole). Hospital-acquired and ventilator-associated pneumonias (HAP/VAP). 🧩 Clinical Takeaway: Reserved for...

Send a text 🧠 Core Concept: Cerebral perfusion pressure (CPP) = MAP – ICP . Normal ICP = ~10 mmHg; threshold for concern >20 mmHg. 🧰 Management Strategies: Elevate head of bed (30°), ensure neck is midline. 3% hypertonic saline preferred over mannitol in AKI. Short-term hyperventilation (↓ PaCO₂ → vasoconstriction). Consider sedation or decompressive craniectomy in refractory cases. External...

Send a text 🧠 Problem: 80% of menopausal women suffer from vasomotor symptoms (hot flashes, night sweats). Many can't take hormone therapy (VTE, CAD, breast CA). 💊 Fezolinetant: NK3 receptor antagonist — first in class. Reduces frequency and intensity of hot flashes. Safe in patients who can’t take estrogen . ⚠️ Side Effects: GI symptoms, transaminitis. Requires liver function monitoring....

Send a text 🧠 Historical practice: Pre-load clopidogrel (or ticagrelor) before cath. Rationale: reduce thrombotic burden prior to PCI. 🧪 New Data: Large observational study: 100k+ NSTEMI patients. No benefit in MI or death with pretreatment. Longer LOS , delayed CABG in pre-treated patients. 🧩 Clinical Takeaway: Defer P2Y12 until coronary anatomy is known — especially if CABG is on the table. I...

Send a text 🧠 Surprising contender: OA is not just wear-and-tear — there's an inflammatory phenotype. 🧪 Trial: MTX 10–25 mg/week in knee OA with persistent pain. Significant ↓ pain and improved function vs placebo. ⚠️ Side Effects: GI upset, mouth ulcers, fatigue. Hepatotoxicity, myelosuppression, pulmonary fibrosis (rare). Always co-prescribe folic acid . 🧩 Clinical Takeaway: Consider in...

Send a text 🧪 The EPOC Trial: Compared FLOT chemotherapy alone vs chemo + radiation before surgery in localized esophageal/gastroesophageal adenocarcinoma. 📈 Findings: FLOT alone led to better 3-year progression-free survival : 51.6% vs 35%. No survival benefit from adding radiation. Patients receiving FLOT alone had fewer complications , improved tolerance, and less treatment-related morbidity....

Send a text 📊 What It Is: A modern CV risk estimator developed from 2.3 million-person dataset. Replaces outdated ASCVD calculator (based on 25k). 🧠 Features: Adds BMI, GFR, A1C, and zip code . Omits race — more equitable. Outputs risk of heart disease, stroke, heart failure . ⚠️ Caveats: Generally gives lower risk estimates vs ASCVD. May reduce statin overuse , but some feel it's too conse...

Send a text 🧪 Study: Retrospective look at patients with intracranial hemorrhage (ICH) on warfarin for mechanical valves. Followed for stroke, rebleed, mortality. 📈 Findings: Only 2 strokes in first 7 days after stopping warfarin. Most resumed warfarin around day 7 with low rebleed risk . ⚠️ Exclusions: Massive bleeds, unstable patients, large hematomas may require longer delay. 🧩 Clinical Take...

Send a text 🧠 Problem: RLS causes chronic sleep disruption , often worsens in hospital or peri-op settings. 💊 Management: First-line : Gabapentin or Pregabalin (per American Academy of Sleep Medicine). Avoid long-term dopamine agonists — cause augmentation and impulse control disorders. 🩸 Bonus Tip: Check ferritin — keep it >75 ng/mL . Oral or IV iron can help symptom control. 🧩 Clinical Ta...

Send a text 🧪 VOYAGER-PAD Trial: Patients with PAD post lower extremity revascularization . Rivaroxaban 2.5 mg BID + aspirin vs aspirin alone. 📈 Results: ↓ Major Adverse CV Events (MACE). ↓ Major Adverse Limb Events (MALE). Modest ↑ in bleeding — no ↑ in fatal bleeds. 🧩 Clinical Takeaway: Now guideline-endorsed for symptomatic PAD post-intervention. Risk-benefit conversation needed in high-blee...

Send a text 🧪 Key Insights: Observational data links semaglutide (GLP-1 RA) to increased risk of non-arteritic anterior ischemic optic neuropathy (NAION) . Incidence: ~9–15 cases per 100,000 patient-years. Possible mechanism: GLP-1 receptors in optic nerve ganglion cells . No proven causality yet — retrospective study only. 🧩 Clinical Takeaway: Risk remains very low . Discuss with patients who h...

Send a text 🧪 Key Findings: Cohort study: SGLT2 inhibitors led to significantly lower rates of nephrolithiasis compared to GLP-1 RAs. Mechanism: increased urinary flow and uric acid excretion . 🔢 Stats: NNT = 20 for prevention. NNT = 5 for recurrent stone formers. 🧩 Clinical Takeaway: Another bonus benefit of SGLT2 inhibitors . May sway decision in diabetics prone to stones. HCTZ no longer hold...

Send a text 🧠 Clinical Tool: Spot urine sodium 2 hours after IV loop diuretic . If <50–70 mmol/L → inadequate response . Consider doubling dose or switching loop agents. 💡 Tips: Also assess urine output in first 6 hours (<100–150 mL/hr = poor response). Less helpful after 24 hrs or in chronic diuretic users. 🧩 Clinical Takeaway: Fast, practical guide to assess diuretic effectiveness in ac...

Send a text 🧪 Study: Patients ≥55 with no relapses in 5 yrs and no new lesions in 3 yrs may stop disease-modifying therapy (DMT) . No significant difference in disability progression. 🧩 Clinical Takeaway: De-escalation strategy in stable MS may reduce cost and side effects . Still requires close neurology follow-up .

Send a text 💊 Study: SURMOUNT-HF trial — patients with obesity and HFpEF. Tirzepatide = ↓ HF hospitalizations and ↑ quality of life. 📈 Benefits: Significant weight loss. Better metabolic profiles. GI side effects: ~6% (nausea, diarrhea). 🧩 Clinical Takeaway: A major contender for cardio-metabolic syndrome with HFpEF. More than just a diabetes or weight-loss drug.

Send a text 🧪 Trials: RESHAPE-HF2 : ↓ HF hospitalizations with transcatheter edge-to-edge repair vs medical therapy. MATTR : Transcatheter approach non-inferior to surgical repair. 🧩 Clinical Takeaway: Game-changing for patients too high risk for surgery. Less peri-op risk, faster recovery — mitral repair is heading the way of TAVR.

Send a text 🧠 Study: Compared transfusion thresholds of Hgb <8 vs <10 in subarachnoid hemorrhage. 📊 Findings: No difference in modified Rankin Score at 12 months. Fewer transfusions, fewer complications in <8 group. 🧩 Clinical Takeaway: Restrictive transfusion strategy is safe in neuro ICU. Less exposure = better outcomes.

Send a text 🧪 Study: TXA within 2 hrs of ICH did not reduce hematoma expansion . No benefit in functional outcome or mortality. ⚠️ Note: Slight ↑ in thromboembolic events (3% vs 1%). 🧩 Clinical Takeaway: No routine use for TXA in spontaneous ICH. Still potential niche use in select trauma cases .

Send a text 🧪 Study: Vitamin K2 (180 mcg) reduced nocturnal leg cramps in elderly. 📉 Results: Cramps/week ↓ from 3.6 → ~1 over 8 weeks. Safe and well-tolerated. 🧩 Clinical Takeaway: Consider a K2 trial in patients with chronic cramps — especially if sleep-disrupting. Avoid in patients on warfarin .

Send a text 🧠 Trial: DOAC started at 3 days vs 8–14 days post-stroke in AF patients. 📊 Results: No ↑ bleeding. No ↑ ischemic events. 🧩 Clinical Takeaway: Safe to start within 4 days in mild to moderate stroke . Still tailor based on infarct size and bleeding risk.