Cardiology
Nephrology
Infectious Disease
RANDOM
100

A patient with septic shock has:

  • Troponin 2,000
  • HR 140
  • Lactate 8
  • No chest pain
  • No ischemic ECG changes

The team wants to start a heparin drip for "NSTEMI."

Should you start Heparin drip? 

BONUS: what lab do we trend and how often. 

his is more consistent with:

Acute myocardial injury or Type II MI from supply-demand mismatch

Treat:

  • Sepsis
  • Hypoxia
  • Hypotension
  • Tachycardia

Heparin treats coronary thrombosis, not myocardial stress.

100

A patient presents with a sodium of 122 mEq/L.

What is the first laboratory test you should check to classify the hyponatremia?

Serum Osmolality
100
Patient from the community comes in for SOB. Found to have radiological evidence of pneumonia. What Labs do you want to collect? (Name 5)


BONUS: Which antibiotics are you starting.

Sputum Culture

Legionella Culture

Legionella and Streptococcus Urine Antigen

MRSA nasal swab

Mycoplasma IgM antibodies

Gen Mark viral panel

Ceftriaxone and Azithromycin/ Doxycycline

100

You are covering Silver Team and you notice that no blood pressures are controlled. Nurse messages you that patient has BP of 170/100 mmHg. You quickly review the chart and see patient is admitted for stroke. What are the next steps?

BONUS: Patient is actually admitted for Sepsis 2/2 UTI, has AKI on labs and bradycardia. Which blood pressure medication class is a safe bet?

1. Are we still allowing for permissive hypertension? Once neurologically stable (typically after the acute 48–72 hour window), the 2025 AHA/ACC guideline recommends initiating antihypertensive therapy targeting SBP/DBP <130/80 mm Hg for secondary stroke prevention

2. Amlodipine 

200

You are on NF and the RN messages you that telemetry is showing tachycardia to 160. You order a stat EKG. ECG shows:

  • Narrow QRS
  • Regular rhythm
  • Rate 180
  • No visible P waves

What is the Diagnosis?

BONUS: What is the first and second line treatment?

SVT

1. Vagal Maneuvers

2) Adenosine

200

 Patient has:

  • Na: 118
  • Serum Osm: 260
  • Urine Osm: 450
  • Urine Na: 60

What is the most likely diagnosis?

SIADH

Urine Osmolality > 100

Urine Sodium > 40

Euvolemic on exam

200

Name two minor Duke criteria for infective endocarditis.

  • Fever ≥38°C
  • Predisposition (e.g., IV drug use, prosthetic valve, prior endocarditis, certain congenital heart disease)
  • Vascular phenomena (e.g., Janeway lesions, arterial emboli, mycotic aneurysm)
  • Immunologic phenomena (e.g., Osler nodes, Roth spots, glomerulonephritis, positive rheumatoid factor)
200

Patient comes in with Sepsis 2/2 Pneumonia. Blood cultures are collected on admission and are preliminarily growing gram positive cocci in pairs and chains. What study should you order immediately?

ECHO

order in setting of gram positive bacteremia, cannot say its contamination yet. 

Also repeat blood culture to see if it is contamination

300

Name the four medication classes that make up the modern "four pillars" of HFrEF therapy.

  1. ARNI / ACE inhibitor / ARB
  2. Beta Blocker
  3. Mineralocorticoid receptor antagonist (MRA)
  4. SGLT2 inhibitor


300

A patient has:

  • K⁺ 7.2
  • Peaked T waves

What medication should be given first?

BONUS:

IV calcium gluconate

Calcium:

  • Stabilizes cardiac membrane
  • Does NOT lower potassium
300

What are the oral options for Pseudomonas? (if sensitive)

Ciprofloxacin 

Levofloxacin

300

Patient comes in for abdominal pain. Everyday drinker of 500 cc of Vodka. LFT shows AST:ALT ratio > 2. Which 2 scores should you calculate?  

Maddrey's Score 

MELD 

400

A patient is started on long-term amiodarone for AFib rhythm control.

Name four toxicities that require monitoring.

  • Pulmonary fibrosis
  • Thyroid dysfunction
  • Liver toxicity
  • Corneal deposits/optic neuropathy
  • QT prolongation
400

What ECG change is associated with hypercalcemia?




HYPERcalcemia: Short PR interval

400

What are the indications to start steroids in CONFIRMED PCP pneumonia in an HIV+ patient?

Room air PaO₂ <70 mmHg

 A-a gradient ≥35 mmHg

400

Apixaban (Eliquis) 2.5 mg twice daily is indicated when ≥2 of the following 3 criteria are met:


BONUS: Does this apply to patients on Eliquis for Afib, DVT/PE, or both?

  1. Age ≥80 years

  2. Body weight ≤60 kg

  3. Serum creatinine ≥1.5 mg/dL


ONLY FOR Afib. CANNOT do this when giving acute eliquis for DVT/PE.


500

A 66-year-old man with new atrial fibrillation has:

  • No CHF
  • No HTN
  • No diabetes
  • No stroke history
  • No vascular disease

Should anticoagulation be started?

*BONUS*

CHA₂DS₂-VASc = 1 (age only)

Management depends on:

  • Individual bleeding risk
  • Patient preferences
  • Shared decision-making
500

At what eGFR level should you become particularly cautious with iodinated contrast?


Answer:

eGFR <30 mL/min/1.73 m²

Teaching Point:

For patients with:

  • eGFR ≥30 → IV contrast is generally acceptable when clinically indicated
  • eGFR <30 or AKI → carefully weigh risks and benefits
500

Lyme testing is positive. What other infections should be tested for?

Babesiosis (and Anaplasmosis) should always be tested for when Lyme disease is confirmed, as these infections are transmitted by the same Ixodes tick vector and coinfection is common.

500

Patient is admitted for COPD exacerbation and started on steroids. What effects in labs will you see reflected that can be attributed to steroids rather than patient condition? Name 3. 

1. Increased neutrophils

➡️ Demargination of neutrophils

2. Hyperglycemia

➡️ Insulin resistance + increased gluconeogenesis

3. Elevated BUN

➡️ Protein catabolism → increased urea production

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