Amanda Perkins @abrunck1 on GrepMed

Pulmonary Embolism - Diagnostic Algorithm - Dr. Eric Strong @DrEricStrong - Strong Medicine https://www.youtube.com/c/EricsMedicalLectures/ #Pulmonary #Embolism #Diagnosis #Algorithm #AcutePE

Emergent Causes of Headache and Associated Risk Factors Carbon monoxide poisoning - Breathing in enclosed or confined spaces with engine exhaust or ventilation of heating equipment - Multiple household members with the same symptoms - Wintertime and working around machinery or equipment producing carbon monoxide (eg, furnaces) Meningitis, encephalitis, abscess - History of sinus or ear infection or recent surgical procedure - Immunocompromised state - General debilitation with decreased immunologic system function - Acute febrile illness—any type - Extremes of age - Impacted living conditions (eg, military barracks, college dormitories) - Lack of primary immunization Temporal arteritis - Age > 50 - Females more often than males (4:1) - History of other collagen vascular diseases (eg, systemic lupus) - Previous chronic meningitis - Previous chronic illness, such as tuberculosis, parasitic or fungal infection Glaucoma—acute angle closure - Not associated with any usual or customary headache patterns - History of previous glaucoma - Age >30 - History of pain increasing in a dark environment Increased intracranial pressure - History of previous benign intracranial hypertension - Presence of cerebrospinal fluid (CSF) shunt - History of congenital brain or skull abnormalities - Female gender - Obesity Cerebral venous sinus thrombosis - Female gender - Pregnancy, peripartum, hormone replacement therapy or oral contraceptive use - Prothrombotic conditions Reversible cerebral vasoconstriction syndrome - Episodic sudden severe pain, with or without focal neurological findings or seizure - Recurrent episodes over a period up to several weeks - Exposure to adrenergic or serotonergic drugs - Postpartum state Subarachnoid hemorrhage (SAH) - Sudden and severe pain; "worst headache of life" - Acute severe pain after sexual intercourse or exertion - History of SAH or cerebral aneurysm - History of polycystic kidney disease - Family history of SAH - Hypertension—severe - Previous vascular lesions in other areas of the body - Young and middle-aged Subdural hematoma - History of alcohol dependency with or without trauma - Current use of anticoagulation Epidural hematoma - Traumatic injury - Lucid mentation followed by acute altered mentation or somnolence - Anisocoria on physical examination #headache #redflags #signs #symptoms #differential #emergency #diagnosis

Anisocoria algorithm - Solid arrows indicate recommended approaches to diagnosis. Dotted arrows indicate optional workup. #Anisocoria #algorithm #ophthalmology #diagnosis #differential

Urine Microscopy - Urinary Sediment Examination Instructions Preparation of the urine for microscopic examination: • Clean catch or catheterized fresh urine, AM first or second void if possible • If collected from a foley catheter, request fresh urine from tubing, not from bag • Perform dipstick testing, note the PH, specific gravity and the presence of protein, blood or leukocyte esterase • Fill conical bottom test tube with urine • Fill another tube with an equal volume of water as a counterbalance • Centrifuge at 1500-1800 rpm (or RCF of 400) for 5-7 minutes • Pour off the supernatant leaving only 0.5 to 1 ml • Resuspend the sediment by gently flicking the bottom of the tube • Add one drop of SM stain if desired and allow 1 minute for stain uptake • Alternatively, to better identify lipids, add 3-5 drops Of Sudan Ill stain and allow 5-10 minutes for uptake • Note - you can add Sudan III stain to sediment that has already been stained with SM. It will displace any SM stain taken up by cells or casts and will stain lipid elements instead • Use a pipette to transfer one drop of urine sediment to a glass slide and cover with a glass coverslip • Do not use plastic or multi-well slides commonly used in central labs Microscopy technique: • Use a high quality microscope with xl 00, x400, and xl 000 magnification • Ensure microscope objective, eyepiece, and condenser lenses are always clean • Verify proper illumination of the specimen (Köhler Illumination) by adjusting the field diaphragm and condenser focus • Use different illumination modalities if available - Bright-field offers the best resolution but the least contrast (best when used with SM stain) -Add contrast by adjusting the iris diaphragm - note that this will decrease resolution in the process - Darkfield is useful for rendering unstained or transparent elements against a dark background. Facilitates identification of lipids (especially with Sudan Ill stain) and crystals - Phase_contrast enhances contrast, but at the expense of resolution. Very useful for identifying dysmorphic RBC's, lipids, crystals, and visualizing the protein matrix of casts - Polarization is useful for identification of lipids, crystals, and contaminants Dr. Jay R. Seltzer @jrseltzer #Urine #Microscopy #Urinary #Sediment #Examination #Instructions #steps #checklist

Simplified Approach to Acute Kidney Injury (AKI) 1) IS THIS AN EMERGENCY? Is there a dialysis indication (e.g AEIOU ) or anuria that may require urgent nephrology evaluation? 2) HISTORY/PHYSICAL Assess if patient has common culprits: Hypovolemia, Low effective circulating volume, Urinary obstruction, Nephrotoxic drugs (e.g NSAlDs) 3) FIX THE PROBLEM ~80% of AKI cases are caused by prerenal azotemia or postrenal obstruction: • Trial isotonic fluids (NS or LR) • Obtain post-void residual to assess for obstruction 4) EVALUATE FOR IMPROVEMENT If the urine output and creatinine (in 12-24 hours) has improved, you confirmed diagnosis! If not. go on to step 5... 5) CONSIDER INTRINSIC CAUSES Assess UA w/ microscopy for WBCs, RBCs, casts, crystals, protein. - 80% of intrinsic etiologies due to ATN. • Rx: Time + minimize culprit - Dr. Michael Lorinsky @LorinskyMD #AKI #Acute #KidneyInjury #simplified #workup #diagnosis #nephrology

# Acute Kidney Injury # AKI #algorithm #differential #nephrology

Definitions of AKI, CKD, AKD Acute Kidney Injury (AKI): • Increase in SCr by 2 50% within 7 days, OR • Increase in SCr by 2 0.3 mg/dl (2 26.5 gmol/l) within 48 hours, OR • Oliguria Chronic Kidney Disease (CKD): • GFR < 60 ml/min per 1.73 m2 for > 3 months • Kidney Damage > 3 months Acute Kidney Diseases and Disorders (AKD): • AKI, OR • GFR < 60 ml/min per 1.73 m2 for < 3 months, OR • Decrease in GFR by ≥ 35% or increase in SCr by > 50% for < 3 months • Kidney Damage < 3 months No Kidney Disease (NKD): • GFR ≥ 60 ml/min per 1.73 m2 • Stable SCr without AKI/AKD/CKD • No structural damage #AKI #CKD #AKD #Definitions #nephrology #acute #kidneyinjury

Mixed Urinary Incontinence: Pathogenesis and Clinical Findings Urgency Urinary Incontinence (UUI) -> Urinary leakage preceded by a sudden, strong urge to void -> Overflow Incontinence -> Overfilling of the bladder from obstruction; BOO (tumour, stone, BPH, urethral or bladder neck stricture) -> Detrusor Overactivity -> OAB (idiopathic), CNS lesion (neurogenic), inflammation/ infection (cystitis, UTI), diabetes mellitus -> Bladder Wall Compliance -> Progressive increase in intravesicle pressure during bladder filling pushing urine from the bladder Stress Urinary Incontinence (SUI) -> Episodic involuntary urinary leakage with sudden increase in intra-abdominal pressure -> Urethral hypermobility, intrinsic sphincter deficiency, or a poorly coapting urethra -> Decreased Pelvic floor muscle and ligament strength causing Decreased tone of vesicoureteral sphincter unit; Decreased urethral strength and associated striated and smooth muscle; iatrogenic - Failure to Void - Weak Stream (+/- dribbling), Intermittent, Straining, Incr PVR if a complication of urinary retention; obstruction visible on cystoscopy - Failure to Store - Frequency, Urgency, Nocturia, Dysuria if SUI or UUI not caused by obstruction - Urodynamic Studies - SUI — Decr urethral closure pressure with incr IAP/Bladder Volume and urinary leakage. UUI— involuntary detrusor contraction and/or detrusor sphincter dyssynergia #Urinary #Incontinence #Mixed #Pathophysiology #Signs #Symptoms #Urology #Diagnosis

Lower Urinary Tract Infections: Complications - Infection damages the urinary tract epithelium causing fibroblast proliferation and collagen deposition -> Urinary Tract Scarring - Infection of the lower urinary tract ascends/extends above the bladder -> Infection of the kidney parenchyma -> Pyelonephritis - Bacterial toxins and inflammation damage epithelial barrier -> Bacteria gain access to blood supply -> Widespread cytokine release resulting in a systemic inflammatory response -> Urosepsis - In males, bacteria from urethra travel to prostate via prostatic ducts -> Prostatitis - Urease-producing bacteria (Proteus, Klebsiella) degrade urea which may cause supersaturation of urine -> Struvite stones (Ca2+, Mg2+, PO43-, NH3) #Lower #UrinaryTractInfection #LUTI #Pathophysiology #Complications

Common Radiation Patterns of Abdominal Pain • Hepatic and biliary pathology - R shoulder • Pancreatitis, AAA - Back • Pyelonephritis - Flanks • Nephrolithiasis (kidney stones) - Groin - Dr. Eric Strong @DrEricStrong - Strong Medicine https://www.youtube.com/c/EricsMedicalLectures/ #Abdominal #Pain #Patterns #Radiation #diagnosis #differential