Medicine

Question 1

Tx of new thrombosis?

Answer 1

Lovenox for 5 days parenenterally

6th day: start Pradaxa

As per Agarwal

Question 2

Bradycardia w/pulse ACLS algorithm (typically <50/min)

Answer 2

id and tx the cause

If clinical consequences:
Atropine IV: 1 mg; 🔂 q3-5 min to max 3 mg;

If ineffective:
Transcutaneous pacing
or
Dopamine IV 5-20 mcg/kg/min
or
Epinephrine IV 2-10 mcg/min

If inefeective, expert consultation or transvenous pacing

Question 3

Intervention for \ opioid use around surgery?

Answer 3

Reduce (cut dose by 50% as not associated with more refills)

Replace (may NSAIDs / risk of leak in colorectal surgery; Gabentin no effect; more visual disturbances)

Educate (Pre & Post Op teaching: more sense of control, \ pills, / disposal)

Communicate (scheduled NSAID/Tylenol ~ Rp. ~last 24hrs utilization of opioids): 0pills: Rp#5; 1-3 pills - Rp #15; >4 pills-Rp #30

Question 4

DVT prophylaxis in patients undergoing major surgery for cancer (open, laparoscopic or pelvic) - ASCO 2019

Answer 4

/\ 7-10 days

Up to 4 weeks for pts with high-risk features:
-restricted mobility
-obesity
-h/o DVT
-additional risk factors

Question 5

Khorana score, predictive of chemo associated VTE in the ambulatory setting: high risk =3, low risk =0;
Categories 5:

Answer 5

1 point per /:
Gyn ca
PLT> 350 K b chemo
Hgb < 10g/dL or Epo
WBC > 11K b chemo
BMI >35

Question 6

Pregnancy: best imaging study and oral contrast?

Answer 6

whole-body diffusion-weighted MRI (WB-DWI/MRI) with pineapple juice (negative contrast)

per Rich Sibley: abd/pelvis with diffusion weighted sequences

gadolinium contraindicated

Question 7

Cryoprecipitate response (indications: >10uPRBC/24hrs; fibrinogen <100 & surgery)

Answer 7

1 u of cryo per 10kg —- / fibrinogen by 50 mg/dL

Question 8

PLT transfusion response?

Answer 8

1u =?40-70mL —- / by 5-10 K/mL

PLT count required before and after

Question 9

FFP indications?

Answer 9

INR>1.6 and/or PT>16sec

Acute blood loss anemia with measured or anticipated EBL of 15-30% of total blood volume

Question 10

PRBC indications
(Compendium of Transfusion Practice Guidelines, Red Cross 2021)

Answer 10

Hgb < 7

Hgb < 8 with ischemic risk: inadequate cardiac output, h/o MI, CAD, stroke, PVD, chronic pulmonary disease, tachycardia and hypotension)

EBL of 15-30 of total blood volume, regardless of current hgb level

Question 11

Massive Transfusion per ACS?

Answer 11

4 u PRBC/hr

10u PRBC/24 hrs

Call Blood Bank: “initiate emergency release protocol” (4u) or initiate MTP

Question 12

What activity determines METS <4 activity level?

Answer 12

Not able to:
-walk 2 city blocks
-climb 1 flight of stairs while holding bag of groceries

Question 13

Dropping chances of survival with with each minute of delay in initiation of CPR and AED?

Answer 13

\ by 7-10%

Question 14

DOAC for A.Fib before surgery per PAUSE trial 3007 pts: 1 d for low risk and 2 d off for high risk before and after the procedure: complications?

Answer 14

<2% major bleeding

<0.5% ischemic stroke

if DVT > 30 d ago —> the same

If dabigatran = Pradaxa and CrCl 30-50 - one additional day of interruption b high risk surgery