Plasma glucose Fasting (8hr) normal 7mmol/l Post prandial (2hr post 75g glucose load) normal 11mmol/l

Clinical Cutoffs/parameters Flashcards by Lian Dimaro

Indications LTOT

PaO2< 7.3 or

PaO2 7.3 - 8 with cor pulmonale or polycythaemia

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Transudate and exudate

Exudate> 35g/L
Transudate <30g/L

Light’s criteria
If pleural fluid protein level between 30 and 35 g/L (i.e.borderline) use Light’s criteria – exudate if one or more of the following:
Pleural fluid/Serum protein >0.5
Pleural fluid/Serum LDH >0.6
Pleural fluid LDH > 2/3 of the upper limit of normal

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Indications for Acute Dialysis

Persistent hyperkalemia >7mM
Refractory pulmonary oedema
Symptomatic uraemia: encephalopathy, pericarditis
Severe metabolic acidosis pH <7.2
Poisoning e.g. Aspirin

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Renal failure

Stage 1 >90 (eGFR)
Stage 2 60-89
Stage 3a 45-59
Stage 3b 30-44
Stage 4 16-29
Stage 5 <15

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Stop metformin when?

Creatinine above 150 µmol/L

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Urology referral criteria - urgent and routine

Urgent referral (i.e. within 2 weeks)

Aged >= 45 years AND:
unexplained visible haematuria without urinary tract infection, or
visible haematuria that persists or recurs after successful treatment of urinary tract infection

Aged >= 60 years AND have unexplained nonvisible haematuria and either dysuria or a raised white cell count on a blood test

Non-urgent referral

Aged 60 >= 60 years with recurrent or persistent unexplained urinary tract infection

Since the investigation (or not) of non-visible haematuria is such as a common dilemma a number of guidelines have been published. They generally agree with NICE guidance, of note:
patients under the age of 40 years with normal renal function, no proteinuria and who are normotensive do not need to be referred and may be managed in primary care

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Diabetes cut offs

Plasma glucose

Fasting (8hr) normal <6; impaired 6-7; diabetes >7mmol/l

Post prandial (2hr post 75g glucose load) normal <7.8; impaired 7.8-11; diabetes >11mmol/l

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Criteria for safe asthma discharge

PEFR >75%
Stop regular nebulisers for 24 hours prior to
discharge
Inpatient asthma nurse review to reassess inhaler
technique and adherence
Provide PEFR meter and written asthma action plan
At least 5 days oral prednisolone
GP follow up within 2 working days
Respiratory Clinic follow up within 4 weeks
For severe or worse, consider psychosocial factors

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Chronic limb ischaemia

Ankle artery pressure <50mmHg
AND either:
Persistent rest pain requiring analgesia for >2 weeks or
Ulceration/ gangrene

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Critical limb ischaemia

Rest pain
Ulceration
Gangrene

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Buerger’s angle

> 90 normal
20-30 ischaemia
<20 severe ischaemia

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ABPI

Calcification >1.4
Normal > 1
Asymptomatic (Fontaine 1) 0.8-0.9
Intermittent claudication (Fontaine 2) 0.6 - 0.8
Rest pain (Fontaine 3) 0.3 - 0.6
Gangrene and ulceration (Fontaine 4) <0.3

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Endarterectomy

Symtpomatic (ECST, NASCET):
70-99%
>50% if low risk
perform within 2wks of presentation

Asymptomatic (ACAS, ACST)
>60% benefit if low risk

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Aneurysm

Dilation of blood vessel >50% its normal diameter

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AAA monitoring

<4cm yearly US

4-5.5: six monthly US

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ABPI for 4 layer graded compression bandage

> 0.8

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Jaundice visible at what bilirubin concentration

50uM (normal 3-17)

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AST:ALT ratios and cause

AST:ALT >2 = EtOH
AST:ALT<1 = Viral

Serum Ascites Albumin Gradient (SAGG)

SAAG >1.1g/dL = portal HTN (cirrhosis in 80%)

SAAG <1.1G/dL = Other causes (neoplasia, inflammation, infection, nephrotic syndrome)

ECG territories and coronary arteries

Anteroseptal = V1-4 (LAD)
Lateral = V5-6 (Cx)
High Lateral = I, aVL (Cx)
Inferior = II, III, aVF (RCA)

How to calculate alcohol units.

For example, to work out the number of units in a pint (568ml) of strong lager (ABV 5.2%):

strength (ABV) x volume (ml) ÷ 1,000 = units

e.g. 5.2 (%) x 568 (ml) ÷ 1,000 = 2.95 units

MMSE scores and dementia severity

25-30 Normal
21-24 Mild
10-20 Moderate
<10 Severe

Asthma exacerbation levels

Near fatal
Life threatening
Severe
Moderate

MMSE scores

Normal 25-30
Mild 21-24
Moderate 10-20
Moderate severe 10-14
Severe <10

Lithium therapeutic index and toxicity levels

Normal 0.6-1.0 (aim for 0.8) Toxicity - anything over 1.2

Normal protein excretion

<150mg/day Although urine dipstick unreliable as are 24hr collections - use protein or albumin:creatinine ratios on early morning MSU

Impaired glucose tolerance

Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l

Impaired fasting glucose

A fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l implies impaired fasting glucose (IFG)

Primary pneumothorax - cut off for aspiration and chest drain

if the rim of air is < 2cm and the patient is not short of breath then discharge should be considered otherwise aspiration should be attempted if this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted

Secondary pneumothorax - cut off for aspiration/ drain/ observation

if the patient is > 50 years old and the rim of air is > 2cm and/or the patient is short of breath then a chest drain should be inserted. otherwise aspiration should be attempted if the rim of air is between 1-2cm. If aspiration fails (i.e. pneumothorax is still greater then 1cm) a chest drain should be inserted. All patients should be admitted for at least 24 hours if the pneumothorax is less the 1cm then the BTS guidelines suggest giving oxygen and admitting for 24 hours

How long before can drive post MI?

4 weeks

SIADH

Hyponatraemia associated with elevated urine osmolality with urine sodium above 20 mmol/l and a low plasma osmolality. (Aassociated with diseases such as pneumonia, bronchial small cell cancer, subarachnoid haemorrhage , pulmonary TB, meningitis, head injury, intermittent porphyria)

Pre-diabetes HbA1c

Prediabetes is defined by a HbA1c of 42-47 mmol/mol (6.0-6.4%)

COPD severity FEV1 % predicted

Mild FEV1> 80% predicted Moderate 50-80% Severe 30-50% Very severe <30%

Aortic valve replacement at what pressure gradient?

>50mmHg

Ejection fraction ratios?

Normal = 50-70% Borderline = 41-49% Heart failure or cardiomyopathy <40 Hypertrophic cardiomyopathy >75%

Degree of aortic stenosis

Mild <25mmHg Mod 25-40 mmHg Sev >40 mmHg Critical >50mmHg

DEXA scoring

T score - comparison to young referenced mean. +1 to -1 = Normal -1 to - 2.5 = osteopenia <2.5 = osteoporosis (Z score - comparison to people of same age)

DKA criteria

Glucose >11mmol/L blood pH <7.3 or HCO3 <15 capillary ketones >3mmol or urinary ketones ++

INR therapeutic targets

INR 2-3: DVT/PE, hypercoagulable states, AF INR 2.5-3.5: aortic metallic heart valves INR 3-4: mitral metallic heart valves

Normal maintenance requirements if NBM

H20+ 1.5ml/kg/h Na +1-2mmol/kg/24h K+ 0.5-1mmol/kg/24 urine output should be >0.5ml/kg/24h

Treatment dose LMWH for PE

1.5mg/kg

Concentrated and dilute urine

Concentrated urine osmolality >300mosm/kg Dilute urine osmolality <250mosm/kg

Metformin prescribing and kidney problems

In adults with type 2 diabetes, review the dose of metformin if the estimated glomerular filtration rate (eGFR) is below 45 ml/minute/1.73m2: Stop metformin if the eGFR is below 30 ml/minute/1.73m2 Prescribe metformin with caution for those at risk of a sudden deterioration in kidney function and those at risk of eGFR falling below 45ml/minute/1.73m2