נקודת מסבב פנימית

Question 1

Target LDL

Answer 1

גבוהה

סיכון:
ֿ# גבוהה מאוד 55
Lipitor 40-80mg
Crestor 20-40mg
# גבוהה 70
Lipitor 40-80mg
Crestor 20-40mg
# בינוני 100
Lipitor 10-20mg
Simovil 20-40mg
Pravalip 40-80mg
Crestor 5-10mg
# נמוך 140
Simovil 10mg
pravalip 10-20mg

Question 2

steroids glucocorticoid / mineralocorticoid activity

Answer 2

dose, GC/MC, duration

Hydrocortisone- 20, 1/1 8-12
Cortisone- 25, 0.8/0.8 8-12

Prednisone- 5, 4/0.8, 12-36
Prednisolone- 5, 4/0.8, 12-36
Methylprednisolone- 4, 5/Minimal 12-36
Triamcinolone- 4, 5/0, 12-36

Dexamethasone- 0.75, 30/Minimal 36-72
Betamethasone- 0.6, 30/Negligible 36-72

Fludrocortisone- **, 10-15/125-150 12-36

Question 3

Albumin

Answer 3

Reduction:
# Liver cirrhosis, leading to:
- Decreased hepatic synthetic capacity
- Greater distribution volume (e.g., due to ascites)
# Loss of protein (e.g., nephrotic syndrome)
# Malnutrition
# Acute or chronic inflammation

Elevation: Dehydration

Question 4

Nailfold capillaroscopy

Answer 4

Uniform and regularly distributed

Normal pattern (primary)
# Uniform and regularly distributed
# Hairpin capillary morphology

Abnormal (scleroderma pattern)
# Decreased capillary density (i.e., dropout)
# Dilated “giant” capillaries (diameter ≥ 50 μm)
# Abnormal architecture
# Hemorrhages

Question 5

Troponin in AF

Answer 5

Troponin levels: to assess for myocardial injury or infarction

can be mildly elevated in rapid Afib due to demand ischemia, acute myocardial infarction must be ruled out as the underlying etiology.
If ischemic cardiac disease is suspected based on clinical presentation and the presence of risk factors but troponin levels are not elevated, the patient should undergo a stress test and/or percutaneous angiography.

Question 6

Pseudothrombocytopenia

Answer 6

Disease factors AI mediated platlet agglutination: e.g., presence of antibodies to EDTA anticoagulant, autoimmune and inflammatory conditions (e.g., cold agglutinin disease), neoplastic disease (e.g., multiple myeloma), viral infections, drugs (e.g., chemotherapeutic agents)

A spuriously low platelet count due to platelet clumping in vitro

Platelet clumping secondary to:
Disease factors AI mediated platlet agglutination: e.g., presence of antibodies to EDTA anticoagulant, autoimmune and inflammatory conditions (e.g., cold agglutinin disease), neoplastic disease (e.g., multiple myeloma), viral infections, drugs (e.g., chemotherapeutic agents)
Pre-analysis collection factors : e.g., sampling technique , choice of anticoagulant used in collection tubes , delays in analysis, improper storage

Question 7

AATR

Answer 7

Amyloidosis: transthyretin amyloidosis (ATTR)
Conditions that result in the accumulation of transthyretin: senile cardiac amyloidosis, familial amyloid polyneuropathy, and familial amyloid cardiomyopathy.

Question 8

D-dimer

Answer 8

fibrin degradation product that correlates with activity of coagulation and fibrinolysis

Use to r/o PE, if <500 PE excluded

High sensitivity: Increased serum D-dimer levels occur in deep vein thrombosis (DVT), pulmonary embolism (PE), and disseminated intravascular coagulation.

Low specificity: Elevation can also occur due to other conditions, including malignancies, infection, pregnancy, renal insufficiency, or surgical procedures.

Question 9

PE CXR findings

Answer 9

frequently normal in patients with PE, they can demonstrate nonspecific findings, such as subsegmental atelectasis or small pleural effusions. Chest x-ray findings suggestive of PE are very rare i.e. Westermark’s sign, Hampton’s hump, vessel paucity.