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Writer's pictureDr. Chris Le
May 10, 2020

Vaping | Clinical Pearls

Title: Vaping

Presenter(s): Dr. Brent Friesen

Date: March 8, 2020

PEARL: Health effects of e-cigarettes

  • Cellular toxicity, inflammation, and impaired immune response

  • Cardiorespiratory changes

  • 3 Fold ↑ Progression to smoking

  • Injuries from explosions & fires

  • Adverse Developmental Effects

  • Psychological effect/impairment

  • Oral Health

PEARL: Benefits & Harms for those who smoke

  • Dual users had higher toxicant exposure than those who smoke cigarettes or e-cigarettes exclusively!

DISCLAIMER: This post contains my interpretation of the presentation. This post is not intended as medical advice. If you have medical concerns, contact a health care provider for assessment. If there are any copyright concerns, please contact me directly to remove the relevant material.

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Writer's pictureDr. Chris Le
May 10, 2020

Alcohol Use Disorder | Clinical Pearls

Title: Alcohol Use Disorder

Presenter(s): Dr. Laura Evans

Date: March 8, 2020

PEARL: Canada's low-risk alcohol drinking guidelines:

  • Women: no more than 3 standard drinks/sitting

  • Men: no more than 4 standard drinks/sitting

  • Standard drink: beer (5% alcohol): 341 mL = 12 oz; wine (12% alcohol): 142 mL = 5 oz; fortified wine (16-18% alcohol): 85 mL = 3 oz; hard liquor (40% alcohol): 43 mL = 1.5 oz

PEARL: 5As Model for Delivering Alcohol Use Brief Intervention

  • Can reduce EtOH intake, sustained up to 1 year

PEARL: First-line pharmacotherapies

  • Goal Abstinence: naltrexone, acamprosate

  • Goal Reduced Drinking: naltrexone (can be initiated while still drinking)

  • CI to Ntx: opioid use, liver failure or acute hepatitis

  • CI to Acamprosate: severe renal impairment, breast feeding

  • Coverage: Ntx (covered) > Acamp (special authorization)

  • Ok to start Ntx if still drinking

  • Acamp safe to start if drinking, but likely < effective

PEARL: Alcohol use disorder medications:

  • Thiamine: usually low in chronic EtOH use, important for brain function, take thiamine for at least 3 mo

  • Folic acid: for thiamine absorption

  • Multivitamin: good measure

DISCLAIMER: This post contains my interpretation of the presentation. This post is not intended as medical advice. If you have medical concerns, contact a health care provider for assessment. If there are any copyright concerns, please contact me directly to remove the relevant material.

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Writer's pictureDr. Chris Le
May 10, 2020

Thyroid Nodule | Clinical Pearls

Title: Thyroid Nodule

Presenter(s): Dr. Sana Ghaznavi

Date: March 8, 2020

PEARL: When you suspect a thyroid nodule

  • Is there really a mass present? Soft tissue (e.g. skin folds); normal neck anatomy (tracheal rings, thyroid cartilage, hyoid bone)

  • Is the mass inside the thyroid or outside the thyroid? Extrinsic lesions (thyroglossal duct cyst, lymph nodes, parathyroid gland)

  • Is the thyroid mass focal or diffuse? Diffuse enlargement (hyperplasia e.g. goitre from iodine deficiency, inflammation e.g. Hashimoto’s thyroiditis, other pathology e.g. lymphoma, large nodule occupying the entire thyroid lobe)

  • Focal lesion: a thyroid nodule!

PEARL: Ddx thyroid nodule

  • Benign: benign (adenomatous) nodule, autonomous (“hot”) nodule, cyst

  • Malignant: primary thyroid cancer (papillary 85%, follicular 5-10%, anaplastic < 1%, medullary 3-5%), other (metastatic from another site - uncommon, primary is usually known; lymphoma - rare)

PEARL: Top reasons NOT to order a neck US

  • Abnormal thyroid function tests (high or low TSH) OR

  • Positive Anti-TPO antibodies (NB: titres do not matter, for Hashimoto's disease, tx with thyroid supplementation anyway)

  • Symptoms of hypothyroidism (e.g. fatigue, weight gain, cold intolerance)

  • In the ABSENCE of a palpable abnormality in the thyroid

PEARL: Choosing Wisely: A Brief Interlude Into Thyroid Labs for Workup of a Thyroid Nodule

  • Screen with TSH only (no free T4 or free T3 needed)

  • No role for TPO antibodies (Hashimoto’s thyroiditis)

  • No role for TSH receptor antibodies [TRAB] (Graves disease)

DISCLAIMER: This post contains my interpretation of the presentation. This post is not intended as medical advice. If you have medical concerns, contact a health care provider for assessment. If there are any copyright concerns, please contact me directly to remove the relevant material.

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