UW Flashcards
Calcium correction based on albumin
For every 1 g/dL decrease in albumin, Calcium goes down by 0.8
BP management in ischemic stroke post-tPA and w/o tPA
During the first 24 hours, the patient needs frequent neurologic checks, no invasive testing or procedures, and strict blood pressure management to keep the blood pressure < 185/105 mm Hg but >140/90 mm Hg to maintain adequate perfusion to the ischemic penumbra and avoid hemorrhagic transformation. Strict blood pressure control is recommended with intravenous (not oral) drugs such as labetalol, nicardipine, and sodium nitroprusside. Hypertension up to a blood pressure of 220/120 mm Hg is generally permitted in patients with acute ischemic stroke who did not receive thrombolytic therapy.
Ddx for Painless hematochezia in a young child (eg 2 yo)
Painless hematochezia includes Meckel’s diverticulum as well as vascular malformations.
What Is A Funnel Plot And How To Read Them?
A funnel plot is helpful in assessing publication bias.
If there is no bias, any scatter between the study results should be due to sampling variation, and 95% of studies should lie within the triangle centered on the summary estimate and extending 1.96 standard errors on either side. Because a larger sample size is associated with increased precision, larger studies (more powerful) will be at the top and have a narrow spread whereas small studies will be scattered widely at the base of the triangle.
What is blepharospasm and how to you treat it?
Blepharospasm is a form of focal dystonia—involuntary eye closure that can be provoked by external stimuli (eg, bright light or irritants). Older women are particularly predisposed to this condition. A potential explanation is that dry eyes in postmenopausal women may serve as a trigger for blepharospasm. Botulinum toxin injections are the mainstay of treatment
Osteopenia T score
When are bisphosphonates indicated?
Osteopenia: t-score of -1.0 and -2.5
Bisphosphonates warranted for those with a risk of hip fracture ≥3.0% or combined major osteoporotic fracture ≥20%.
How is treatment resistant depression defined
Depression that doesn’t respond to adequate trial of 2 antidepressants
Biventricular pacing devices for patients in sinus rhythm who meet all of the following criteria:
biventricular pacing devices for patients in sinus rhythm who meet all of the following criteria:
LV ejection fraction <35%
NYHA class II, III, or IV heart failure symptoms (essentially the presence of any symptoms)
Left bundle branch block with QRS duration >150 msec.
What are complications of psoriasis? (2)
Potential complications include nail and joint involvement. Psoriatic arthritis requires systemic therapy (eg, methotrexate).
Arthritis can proceed skin findings
Preeclampsia; severe fts
Preeclampsia Definition New-onset hypertension (SBP >140 mm Hg &/or DBP >90 mm Hg) at >20 weeks gestation plus Proteinuria &/or end-organ damage
Severe features SBP >160 mm Hg or DBP >110 mm Hg (2 times >4 hours apart) Thrombocytopenia ↑ Creatinine ↑ Transaminases Pulmonary edema Visual or cerebral symptoms
Management
Without severe features: Delivery at >37 weeks
With severe features: Delivery at >34 weeks
Magnesium sulfate (seizure prophylaxis)
Antihypertensives
ECG with increased voltage in the precordial leads indicates…
LV hypertrophy
Asthma exacerbation in pregnant patients (step 1, 2 and SaO2 goal)
is similar to that in nonpregnant patients. An inhaled or nebulized short-acting beta agonist (albuterol is preferred during pregnancy) is given initially, usually in combination with inhaled ipratropium. In patients with persistent symptoms, the next step is the administration of systemic corticosteroids (eg, oral prednisone) without delay; although these drugs have been associated with a slightly increased risk of premature birth, low birth weight, and cleft palate, the benefits of effective asthma exacerbation management outweigh these risks. Supplemental oxygen should be given to maintain SaO2>95% (>90% in nonpregnant patients)
Attributable risk formula
= (Rexp-Runexp)/Rexp
Attributable risk in a population -formula
PARP= risk in population of exp - risk in unexposed/risk in population of exp
Risk in total pop= weighed average of the risk
Lyme disease tx in pregnancy (2)
14-21 days of amoxicillin or cefuroxime.
4Ts of HIT
The likelihood of type 2 HIT is calculated using the 4 Ts score, which includes the following:
Thrombocytopenia - platelets typically decline >30%-50%
Timing - onset 5-10 days after heparin initiation or ≤1 day with prior, recent heparin exposure
Thrombosis - new thrombosis, progressive thrombosis, or skin necrosis
AlTernate causes - no other sources for thrombocytopenia are present or likely
Light’s criteria— Transudative
transudative based on Light criteria, with fluid to serum total protein ratio <0.5, fluid to serum lactate dehydrogenase (LDH) ratio <0.6, and fluid LDH <2/3 the upper limit of normal for serum LDH.
When to suspect endometriosis?
When pt has pain with periods, penetration or BMs. Also infertility
Three indications for starting statin therapy
Diabetic pts 40 and above
LDL >190 or
Pts with 10-yr CVD risk of >7.5-10 (varying guidelines)
Vaccines contraindicated in pregnancy (4)
2 that are okay
HPV, MMR, Live attenuated influenza, varicella
Okay- inactivated flu, Tdap (tetanus toxoid-reduced diphtheria toxoid-acellular pertussis)
How does epiglotitis present? Tx?
Acute onset of fever, respiratory distress, dysphonia (difficulty speaking), stridor, drooling and sitting forward with his neck extended (tripod, sniffing position).
Tx- intubation and abx
Epiglottitis vs croup presentation and imaging
Presentation for croup— barking cough that’s worse w/ agitation and improves w/ cool air/warm shower. 1-few days of URI sx
epiglottitis- see other card. Very acute
Xray: epiglottitis- thumbprint sign
Croup- steeple sign
Stone management
If pt is septic, has ARF or complete obstruction—> consult urology
If not, then management is based on stone size. If <10 mm, gentle hydration, pain control, alpha blocker, and strain urine
For larger stones/uncontrolled pain/no stone passage in 4 weeks—>urology consult for possible surgical management
What is ATN and how do you distinguish it from pre-renal?
Acute tubular necrosis is responsible for most cases of acute renal failure in hospitalized patients. Generally involves a perfusion deficit due to hypovolemia, hypotension, shock, sepsis, or low cardiac output states. The typical presentation is oliguria following a hypotensive episode, with elevated BUN and Cr levels (the ratio is typically normal) and anion gap acidosis. Examination of the urinary sediment usually shows characteristic “muddy brown” casts.
Pre-renal BUN/Cr ration will be >20
Management of DKA
Tx of severe DKA begins with volume repletion with isotonic fluids (eg, NS, LR) given over an hour followed by initiation of an insulin drip. A small bolus given over an hour prior to initiating insulin therapy has been shown to minimize the risk of cerebral edema compared to starting an insulin drip immediately. Potassium-containing intravenous (IV) fluids should be administered simultaneously with the insulin drip for patients with normal or low potassium levels as insulin moves potassium intracellularly and causes hypokalemia.
What labs do you have to check before starting bisphosphates? 2
Bisphosphates can cause hypocalcemia due to decreased bone resorption; IV>po formulations.
So check serum calcium level and vitamin D (25-hydroxyvitamin D level).
How do you manage gestational DM after birth?
Pts with gestational diabetes are screened for 24-72 hours postpartum with fasting blood glucoses and at 6-12 weeks postpartum with a 2-hour oral glucose tolerance test.
Lab abn in acute cholangitis
Cholestatic liver function abnormalities—↑ Direct bilirubin, Alk phosphatase
Mildly ↑ aminotransferases
Biliary dilation on abdominal ultrasound or CT scan
How to distinguish bell’s palsy from stroke?
Tx of bell’s palsy
Forehead wrinkle. If able to wrinkle forehead—> stroke. If it’s the whole half of face—> Bell’s palsy.
Corticosteroids are the treatment of choice for Bell’s palsy—within 3 days. Eye care is extremely important
