Lock, Shock and Two Smoking Barrels
Name 1 blood pressure parameter that would make you suspicious for shock
- SBP < 90?
- MAP < 65
Name the 2 most common scoring systems that predict prognosis of cirrhosis
- Child Pugh
- MELD
Which of the following patients require pharmacological VTE prophylaxis while hospitalized?
A) 57M with reduced mobility and chf on apixaban
B) 57M with reduced mobility and chf on dapt (asa and ticagrelor)
C) 57M with reduced mobility and chf on warfarin
B)
Name the most common cause of upper GI bleeds.
What is Peptic ulcer disease?
This sequel to a 1986 film about fighter pilots is currently the top of the box office world wide.
What is Top Gun: Maverick?
Name 4 categories of shock
- Hypovolemic
- Cardiogenic
- Obstructive
- Distributive
Name 3 cause of cirrhosis
MANY: HCV, HBV, Alcohol, Autoimmune, PSC, PBC, Alcohol, NAFLD, Medications (methotrexate, amiodarone, etc.), A1AT, Wilson, Hemochromatosis, etc.
Name 3 classes of medications you can use to treat VTE
- DOAC
- LMWH
- UFH
- Warfarin (Vitamin K antagonist)
This separates the upper GI tract from the lower GI tract
What is the Ligament of treitz?
Which hard hitting male actor won the Oscars for Best Actor in 2021?
Will Smith, King Richard
Name 3 physical exam findings for anaphylaxis
- Rash/hives/erythema
- Lungs for wheeze
- Oropharynx/throat for swelling
- Diarrhea
- Hypotension
Name 2 diagnostic criteria for spontaneous bacterial peritonitis on analysis of ascites
1) Polymorphonuclear cell (PMN, also referred to as neutrophils) count in the ascitic fluid is ≥250 cells/mm3
2) Culture results are positive, and
3) Secondary causes of peritonitis are excluded
Name 3 contraindications to pharmacological VTE prophylaxis
- Active bleed
- Previous bleed <3 months before hospitalization
- Severe renal failure
- Liver failure
- Active cancer
- Platelets <50
- Surgery in <12h
Name a widely used scoring system to determine inpatient vs outpatient management of GI bleeds.
What is Glasgow-blatchford bleeding score?
Name 3 sequels that are currently in the top 10 worldwide box office.
- Top Gun: Maverick
- Doctor Strange Multiverse of Madness
- Jurassic World Dominion
- Minions: Rise of Gru
- Fantastic Beasts: Secrets of Dumbledore
- Sonic the Hedgehog 2
- Thor: Love and Thunder
Name 4 investigations to evaluate for cardiogenic shock
- CXR
- BNP
- CK
- Tropes
- ECG
- Echo
- VBG
Name a set of criteria for grading hepatic encephalopathy?
What is the West Haven Criteria?
2) Gross disorientation, drowsiness, possibly asterixis, inappropriate behavior
3) Marked confusion, incoherent speech, sleeping most of the time but arousable to vocal stimuli
4) Comatose, unresponsive to pain; decorticate or decerebrate posturing
What are 3 things that give you a score of +3 on the PADUA score?
- Active cancer
- Previous VTE
- Reduced mobility
- Known thrombophilia
Name 3 mimics of melena stools
- Peptobismol
- Licorice
- Iron supplements
Name 3 of the (top 10) highest grossing directors of all time, world wide
- Steven Spielberg (Jurassic Park) - $10.6B
- Russo Brothers (Avengers: Endgame) - $6.8B
- Peter Jackson (Lord of the Rings) - $6.5B
- Michael Bay (Transformers) - $6.5B
- David Yates (Harry Potter and the Deathly Hallows Part 2) - $6.3B
- James Cameron (Avatar) - $6.3B
- Christopher Nolan (Dark Knight Rises) - $5B
- JJ Abrams (Star Wars: Force Awakens) - $4.6B
- Tim Burton (Alice in Wonderland) - $4.4B
- Ridley Scott (The Martian) - $4.3B
Name 2 pressors of choice for septic shock
- Norepinephrine
- Vasopressin
Name 6 complications of cirrhosis
- Portal Hypertension
- Gastric varices/Variceal hemorrhage
- Ascites/SBP
- Hepatic encephalopthy
- Hepatic renal syndrome
- Hepatic pulmonary syndrome
- HCC
- Coagulopathy
- Infections
A) What is a widely used evidence based scoring system that helps determine whether pharmacological VTE prophylaxis is indicated?
B) What is the score cutoff above which you should initiate pharmacological prophylaxis?
C) What are 2 other scoring models Dr Frobb mentioned?
A) PADUA
B) ≥ 4
C) Geneva, Improve-dd
You have a patient with known cirrhosis presenting with an upper GI bleed. What are the 3 medications you start and why?
- PPI - promote healing / reduce acidity
- Octreotide - reduced bloodflow in the sphlanchnic system / reduced blood flow to the gi tract/varices/etc
- Ceftriaxone - reduced rate of bacteremia/translocation/SBP
Name the last 5 Pixar films released
- Lightyear (2022), Turning Red (2022), Luca (2021), Soul (2020), Onward (2020), Toy Story 4 (2019)
- Encanto (2022) is NOT pixar