other

Question 1

deal with albumin

Answer 1

• not a reliable biomarker for nutritional state (influenced by a lot of inflammatory and infectious states)

Question 2

QID MEANS

Answer 2

4 times a day

Question 3

other causes of secondary hypertension

Answer 3

alcohol, pheochromoctyoma, substance use

Question 4

workup of young person with HTN

Answer 4

renal US
BMP with creatinine
+/- sleep study if concerned for OSA

Question 5

1 unit pRBCs should raise hct/hgb

Answer 5

3% and 1g/dL

Question 6

when should you transfuse…

Answer 6

• the goal is to sustain adequate tissue oxygenation but it really depends on peoples ability to respond with increased cardiac output or oxygen intake
• look at HR (but make sure something else isn’t accounting for it)
• so below 7 in hemodynamically stable patients, below 8 in patients undergoing surgery or have cardiovascular disease
• Known CAD = less than 8
• symptomatic (CP-orthostatic hypotension-tachy unresponsive to IVFs) = less than 10

Question 7

what to monitor with large volume transfusions

Answer 7

hypocalcemia (citrate binds it)

Question 8

platelet indications for transfuing

Answer 8

less than 10K

if febrile less than 30K

Question 9

how to manage elevated INR

Answer 9

INR 3-5: hold warfarin
INR 5-9: hold warfarin + give Vitamin K 2.5-5mg
*FFP not routinely advised in absence of bleeding.

Question 10

how to drop INR before procedure (Should be below 1.5 (or even 1.0!)) (but 1.0 is hard to get too)

Answer 10

• intrinsic INR of FFP is 1.3

- give FFP

Question 11

what is cryoprecipitate?

Answer 11

contains fibrinogen, factor 8, factor 13, VW factor and fibronectin

• used in ICU for major bleeding in vWD/factor deficiencies
• used in low fibrinogen states (DIC. goal fibrinogen over 100, liver disease and bleeding, massive transfusion protocols).

*pearl: does not reverse warfarin.

Question 12

type and screen vs. type and cross

Answer 12

type and screen –
– used if transfusion is not likely. screend for ABO, Rh, and common antiboides
type and cross –
– same as above but they take blood from blood bank and mix it with patients blood to make sure there’s no hemolysis/reaction. It’s an additional step. Then specimen is owned by patient and good for 72 hours.

Question 13

length of time for cross-match

Answer 13

about an hour (assuming everything goes perfectly)

Question 14

how to write transfusion order

Answer 14

• be specific in indication
• rate of transfusion = 2 hours is generally fine unless bleeding fast. Or if concerned about volume overload (TACO) then 4 hours. OR if EF is really really low.
• make sure patient has adequate access (blood products need their own lines)

Question 15

special requirements for transfusion

Answer 15

Only needed if…
- heme malignancy
- congenital immunodeficiency
Just call the blood bank (path interns usually have pager)

Question 16

how to manage jehovah’s witness bleeder

Answer 16

give EPO (onset is 4-6 days but can produce 1 unit/week)

Question 17

treatment duration for provoked DVT

Answer 17

3-6 months

Question 18

prediabetes range

Answer 18

5.7-6.4

Question 19

normal blood glucose range

Answer 19

70-100

Question 20

new AHA BP guidelines

Answer 20

• Treat high BP earlier at at 130/80 mm Hg rather than 140/90 in order to account for complications that can occur earlier and to intervene earlier.
• The guidelines eliminate the category of prehypertension, categorizing patients as having either Elevated (120-129 and less than 80) or Stage I hypertension (130-139 or 80-89). While previous guidelines classified 140/90 mm Hg as Stage 1 hypertension, this level is classified as Stage 2 hypertension under the new guidelines.