CLOTTING CASCADE
Which part of clotting cascade does PT / INR measure?
What MEDICAL PATHOLOGIES affect PT / INR?
Which MEDS affect PT / INR?
Extrinsic Pathway
Pathologies: Liver dysfunction / Bleeding
Meds: Warfarin, DOAC, NSAID
Barium swallow findings in
Achalasia
Esophageal spasm
bird beak
corkscrew
This early marker of renal disease. What value is diagnostic and what intervention should be performed?
Microalbumin over 30 --> start ACE
List hepatocell / billiary enzymes
hepatocell: AST / ALT
billiary: ALP, GGT, Bilirubin
This cast is the hallmark finding of nephritic syndrome and glomerulonephritis.
RBC cast
Which are the 3 tests that tell true liver function?
Which is most sensitive?
Which has the longest half life?
1. TPO
2. Albumin ** longest half life
3. PT / INR ** ELEVATED FIRST
How is appendicitis evaluated in
Adults:
Kids
Pregnant
CT
US
MRI
AKI requirements (diagnostics)
1. An increase in serum Cr by {{c1::> 0.3mg/dL::quantity}} in {{c1::48 hours::time }}
2. Increase in serum Cr {{c2::1.5x}} baseline
3. Decrease in urine output {{c3::< 0.5 mL/h::quantity}} over {{c3::>6 h::time}}
List 5 reasons for hepatocellular injury
2. autoimmune hepititis
3. drugs / toxins (ETOH / NSAIDS)
4. Vascular Injury
5. MASLD
6. Genetic: Wilson's / hematochromotosis
What is the smoking gun for UTIs and why
List the 4 tests used to score MELD-Na AND GIVE NORMAL VALUES
What does this give an estimate of?
1. Na
2. Bilirubin
3. Cre
4. INR
What are signs of abdominal infection on CT?
abscess
organ wall thickening
fat stranding
List BUN / Cre ratios for pre renal and intrinsic renal failure. List 2 causes for each
20:1 - pre renal - hypo perfusion. hypovolemia
15:1 - intrinsic - acute tubular necrosis, meds( aminoglycosides , NSAID, ACE)
AST / ALT = 2 signals what
ASL / ALT = 5 signals what
alcoholic liver disease
rhabdo, MI, hemolysis
A urine dipstick is positive for blood, but microscopy shows no RBCs. This finding should raise concern for these two diagnoses.
rhabdomyolysis and hemolysis?
Fill in the following peritoneal fluid analysis:
Bloody-
Milky -
Dark Brown -
Green -
PMN of WHAT VALUE needed to presume bacterial peritonitis?
Bloody- cancer, trauma, post op
Milky - cancer (lymphoma)
Dark Brown - high bilirubin
Green - bile leak
PMN = 250
Indications for IV contrast / PO Contrast
IV: tissues OUTSIDE GI track, fat stranding, access, wall thickening
PO: looking INSIDE GI track
What are the 3 factors which affect GFR?
Which lab values are indirect / direct indicators of GFR?
surface area
permeability
net filtration pressure
Indirect: BUN
Direct: Cre
Patient has elevated GGT / ALP / D.Bili...
What is the next diagnostic step? What are expected findings?
1. Right US
2. ERCP
--> if not dilated on US: intrahepatic duct obstruction / decreased bile production
If a patient presents with a specific gravity of 1.035, what are the three most likely physiological or clinical causes for this "high" concentration?
What are the 3 main causes of pancreatitis?
Which 2 enzymes aids in measuring inflammation?
Which is more sensitive? WHY?
ETOH
Choledocholithiasis
High triglycerides --> 1000
Amylase / Lipase -->Lipase more specific bc amylase also made in salivary glands
Mechanical Bowel Obstruction findings:
XRAY:
CT: BE SPECIFIC
XRAY: air fluid levels
CT: identifiable transition point (air / fluid proximal to obstruction, bowel collapse distal to obstruction)
What are the reasons for increased BUN?
WHY WOULD UREA BE FORMED AT HIGHER RATE?
decreased flow / urea being made at higher rate
BURNS, STEROIDS, FEVER DRUGS
A patient with AST 95, ALT 110, ALP 650, GGT 700, and direct hyperbilirubinemia most likely has pathology involving this anatomical structure.
billiary tree / common bile duct
List all casts
RBC
WBC
Fatty
Muddy Waxy