GI Joy
Nephro S.H.I.T.
C(K)ody AMS
Bees Knees
Clinical How-To
100
List 5 causes of acute pancreatitis
Biliary disease, alcohol, post-ERCP, hypertriglyceridemia, meds (furosemide, mesalamine, thiazides, 6-MP, azathioprine...), infectious, autoimmune, ischemic, neoplastic, celiac, trauma
100
One of the most common reversible causes of apparent diuretic resistance
High dietary sodium
(could also accept: not taking their diuretic)
100
Classic CSF findings bacterial meningitis (broadly speaking):
Leukocyte predominance: __
Glucose level: __
Gram stain: __
Culture: __
Leukocyte predominance: neutrophils
Glucose level: low (<40 mg/dL)
Gram stain: often positive (in 60-90%)
Culture: often positive (in 70-85%)
100
Most sensitive physical exam maneuver for ACL tear
Lachman
100
Name of the clinic scheduler
Jack Scudmore
200
42yoF with acute-onset epigastric pain radiating to the back and normal lipase. Next step?
CT
200
List equivalent doses for oral formulations:
furosemide, torsemide, bumetanide
(200 extra points if you also get ethacrynic acid)
Furosemide 40mg PO
Torsemide 20mg PO
Bumetanide 1mg PO
Ethacrynic acid 50mg PO
200
Most common cause of viral meningitis
(100 extra points: most common pathogen for community acquired bacterial)
Enteroviruses
(community-acquired bacterial: Strep pneumo)
200
When are opioids preferred over NSAIDs for initial treatment of grade I and II knee ligament sprains
Never (do RICE + topical NSAIDs, maybe PO NSAID)
No opioid achieved clinical benefit better than standard NSAIDs
200
Who runs Infusion Clinic
Lt Irene Sumbang
Ms. "Dee Dee" Carmon
300
Duration of an acute peripancreatic fluid collection to call it a pseudocyst
>4 weeks
(also should have a wall, no solid debris/necrosis)
300
What volume of urine output in what timeframe would suggest a "good response" (functioning nephrons) in a furosemide stress test?
>200mL UOP over 2 hours
300
Empiric pharmacotherapy for community-acquired bacterial meningitis in 62 year-old patient
Dexamethasone
Ceftriaxone 2g q12h, vancomycin 15-20mg/kg q8h initially, ampicillin 2g q4h
300
Most sensitive and specific provocative maneuver for suspected meniscal tear
Thessaly
300
Which mailbox to put your return faxes in
Admin
400
Indications for drainage of pancreatic pseudocyst
Symptomatic (pain, GOO, infection, bleeding...)
Or >4cm and persistent >3-6mo
400
Patient prescribed home 80mg PO Lasix daily presents to ER with signs of volume overload. Received 40mg IV Lasix in the ER, IM called to admit for AKI. Two hours later, UOP 120mL and AKI has worsened. Next step?
Give a higher diuretic dose
(probably 80mg IV Lasix to double home dose)
or try more bioavailable option (torsemide, Bumex)
*Elevated Cr is not always a reason to reduce dose*
400
Empiric Abx for patient <50yo and healthcare associated meningitis
Vanc + one:
Cefepime, Merrem, ceftazidime
400
Next step in a patient with acute knee trauma, exam with laxity on varus strain, negative radiographs
MRI without contrast
400
Where to send messages for procedure clinic
USAF Keesler Procedure clinic scheduling
(need imaging at least within the last year)
500
Management of acute peripancreatic necrotic fluid collection
(discuss both medical and procedural/surgical management)
Antibiotics (imipenem-cilastatin, Merrem, Zosyn,cefepime/anaerobic coverage, maybe cipro/Flagyl)
Consider CT-guided FNA --> gram stain/culture
Ideally wait 4 weeks for it to wall off before drainage/debridement/necrosectomy
500
If a patient has functional nephrons and is adherent to a < 2g sodium diet, what should urine sodium excretion be?
<87 mEq Na
At steady state, Na (intake) = Na (excretion)
A 2g Na diet should lead to uNa of 87mEq
500
Suspicion for bacterial meningitis, who has an indication for CT head prior to LP.
1) Name at least 3 indications for CT prior to LP
2) When do you hang the antibiotics?
1) Immunocompromised, hx CNS disease, seizure, papilledema, AMS, focal neuro deficit
2) Antibiotics before CT and LP (ideally grab BCx first)
500
Ottawa Knee Rules - name at least 4
(radiographs indicated if any ONE of the six criteria are met)
Age >55 (>50 per Pittsburgh)
Tenderness of the head of the fibula
Isolated patellar tenderness
Inability to flex knee to 90 degrees
Inability to bear weight immediately after injury
Inability to walk 4 steps in the ED (on presentation)
500
Steps to send a patient from IM clinic to ER
Call ER for doc-to-doc
Notify clinic nurse to accompany patient to ER