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CHADSVASc Score - Stroke Risk in Atrial Fibrillation A clinical mnemonic to estimate stroke risk in atrial fibrillation. A higher total score indicates a greater stroke risk and supports decisions regarding anticoagulation therapy. C Congestive heart failure H Hypertension A2 Age ≥ 75 (2 points) D Diabetes mellitus S2 Stroke / TIA / Thromboembolism V Vascular disease (MI, PAD, aortic plaque) A Age 65–74 (1 point) Sc Sex Category female Score - Yearly Stroke Risk: 0 points - 0.2 % 1 point - 0.6 % 2 points - 2.2 % 3 points - 3.2 % 4 points - 4.8 % 5 points - 7.2 % 6 points - 9.7 % 7 points - 11.2 % 8 points - 10.8 % 9 points - 12.2 % Source: https://pubmed.ncbi.nlm.nih.gov/22246443/ #CHADSVASc #Score #Atrial #Fibrillation #AFib #CHADS2VASc #Diagnosis #neurology #cardiology #Mnemonic

Dihydropyridine Calcium Channel Blockers Mechanism of Action: L-Type calcium channel blockade - Inhibits the influx of calcium into smooth muscle resulting in coronary and peripheral vasodilation Indications: Angina (with rate controlling agent), vasospastic angina, raynauds phenomenon, pulmonary hypertension Side Effects: Hypotension, Flushing, Headache, Reflex Tachycardia, Peripheral edema, Dizziness Agents: Amlodipine, Felodipine, Nifedipine Ashley & Brooke Barlow PharmD @theABofPharmaC #Dihydropyridine #Calcium #Channel #Blockers #CCB #pharmacology

Radial Fracture Due to Parathyroid Carcinoma- ...A plain radiograph of the left arm showed a diaphyseal radial fracture (Panel A, arrow) and a diffusely low-density, mottled appearance of the radius and ulna. Two months before presentation, the patient had received a diagnosis of primary hyperparathyroidism, with an intact parathyroid hormone level of 3590 pg per milliliter (reference range, 10 to 65) and a serum calcium level of 13.0 mg per deciliter (3.25 mmol per liter; reference range, 8.5 to 10.2 mg per deciliter [2.12 to 2.55 mmol per liter]). He underwent parathyroidectomy and was found to have parathyroid carcinoma, which is a rare cause of primary hyperparathyroidism and can manifest as markedly elevated parathyroid hormone levels...A plain radiograph obtained 1 year after the diagnosis of the fracture showed union of the radial fracture and normal-appearing bone density (Panel B). One year after the parathyroidectomy, the patient’s parathyroid hormone level was 48 pg per milliliter and his calcium level was 9.0 mg per deciliter (2.25 mmol per liter). #clinical #radiology #NEJM #parathyroid #carcinoma #diaphyseal #radial #fracture #hyperparathyroidism

Causes of Metabolic Alkalosis - Differential Diagnosis Chloride depletion syndromes • Gastrointestinal losses - Vomiting, nasogastric drainage - Congenital chloridorrhea - High-volume ileostomy drainage - Some villous adenomas • Renal losses - Chloruretic drugs (eg, thiazides, furosemide) - Bartter syndrome - Gitelman syndrome Mineralocorticoid excess syndromes • Primary hyperaldosteronism • Glucocorticoid-remediable aldosteronism Apparent mineralocorticoid excess syndromes • Liddle syndrome • 11 ß-hydroxysteroid dehydrogenase type 2 inhibition or deficiency • Fludrocortisone administration Other causes: • Alkali intake or administration • Milk alkali syndrome • Severe potassium depletion (serum potassium <2 mmol/L) #Metabolic #Alkalosis #Differential #Diagnosis #Causes

Signs and Symptoms Associated With Different Headache Etiologies • Nonfocal mental status changes - Meningitis, encephalitis, SAH, subdural hematoma, anoxia, increased intracranial pressure, carbon monoxide poisoning • Mental status changes with focal findings - Intraparenchymal bleed, tentorial herniation, stroke • Severe nausea, vomiting - Increased intracranial pressure, acute-angle closure glaucoma, SAH, carbon monoxide poisoning • Hypertension with normal heart rate or bradycardia - Increased intracranial pressure, SAH, tentorial herniation, intraparenchymal bleed, preeclampsia, reversible cerebral vasoconstriction syndrome • Tachycardia - Anoxia, anemia, febrile headache, exertional or coital headache • Fever - Febrile headache, meningitis, encephalitis • Tender temporal arteries - Temporal arteritis • Increased intraocular pressure - Acute angle closure glaucoma • Loss of venous pulsations on funduscopy or papilledema - Increased intracranial pressure, mass lesions, subhyaloid hemorrhage, SAH, cerebral venous thrombosis • Acute red eye (severe ciliary flushing) and poorly reactive pupils - Acute angle closure glaucoma • Enlarged pupil with third nerve palsy - Tentorial pressure cone, mass effect (aneurysm, bleed, abscess, or tumor) • Lateralized motor or sensory deficit - Stroke, subdural hematoma, epidural hematoma, hemiplegic or anesthetic migraine (rare), reversible cerebral vasoconstriction syndrome, central venous thrombosis • Balance and coordination deficits - Cervical artery dissection, acute cerebellar hemorrhage, acute cerebellitis (mostly children), chemical intoxication of various types • Extraocular movement deficits (CN Ill, IV, and VI) - Mass lesion, neurapraxia (post-traumatic headache), IIH #headache #signs #symptoms #clues #differential #diagnosis

Initial assessment and management of coma in pediatric population. Airway - is it secure? Breathing — is respiratory effort sufficient? Circulation - treat shock Disability — check blood glucose - AVPU or Glasgow Coma Scale Exposure - e.g. look for meningococcal purpuric rash Examination - Is there raised intracranial pressure — abnormal breathing, posture, pupils, fundi (papilloedema or retinal haemorrhages)? - Bradycardia and hypertension suggest impending brain stem herniation Treat the treatable: - hypoglycaemia - poisoning - diabetes mellitus - septicaemia/meningitis - herpes simplex encephalitis Intubate and ventilate if necessary, transfer to paediatric/neurosurgical intensive care unit #Assessment #Coma #Pediatrics #Peds #ABCs #CriticalCare #Diagnosis

Lumbar spine reporting - Nomenclature Bulge (>25% disc circumference) - Symmetric (Circumferential) - Asymmetric (Not Circumferential) Herniation (<25% disc circumference) - Protrusion base > dome - Extrusion dome > base Based on https://doi.org/10.1016/j.spinee.2014.04.022 Dr. Mark Mamlouk @ https://twitter.com/MarkMamloukMD #Lumbar #Spine #Reporting #Disc #Classification #Nomenclature #Bulge #Herniation #Protrusion #Radiology #Diagnosis #MSK

Common causes of sciatica. Disc herniation is the commonest cause. Spondylolisthesis can cause impingement #Anatomy #Pathophys #Sciatica #Spondylolisthesis #Herniation #BackPain #BMJ

Acid-Base Disorders - Differential Diagnosis Framework • Respiratory Acidosis • Respiratory Alkalosis • Metabolic Acidosis • Metabolic Alkalosis By Kyle Fischer, PharmD @Kfischer_10 #AcidBase #Acid #Base #Disorders #nephrology #differential #diagnosis #acidosis #alkalosis #respiratory #metabolic

Stroke Mimics - Differential Diagnosis - MINT Mnemonic • Metabolic: Hyper-glycemia, Hypoglycemia, Wernicke's encephalopathy, Mitochondrial Encephalopathy with Lactic Acidosis and Stroke-like Episodes (MELAS), HTN Encephalopathy, Hypoxia/Hypercarbia • Infectious: Bell's palsy (HSV), Vestibular neuronitis, CNS abscess • Neurologic: Seizure w/ post-ictal paralysis (Todd Paralysis), Brain Tumor, Traumatic Brain Injury, Migraine with Aura, Multiple Sclerosis, Conversion Disorder • Toxins: Drug toxicity (Toxic) SCVMC Internal Medicine @SCVMCMed #Stroke #Mimics #CVA #Differential #Diagnosis #MINT #Mnemonic #neurology