EKG
Echo
CXR
Drugs
Mix it up
100
A 47-year-old woman presents with four hours of right shoulder pain and diaphoresis. HR 70 reg, BP 177/87, SpO2 95 RA.
An ECG is taken at triage.
The computer reads “inferior ischaemia” – do you agree?
No: Limb lead reversal
This is limb electrode misplacement leading to limb lead reversal. A northwest axis in an ECG with normal precordial leads simply does not make sense.
- wave axis is abnormal – upright in aVR, negative in II – this is seen with ectopic atrial rhythms
- Northwest axis
- Q waves and T-wave inversion in leads I, II, III, aVF
- Precordial R wave progression is preserved
100
What is the HR goal in the condition shown below?
What is 60bmp? (proximal aortic dissection)
100
What is the finding shown below?
What is pneumomediastinum?
100
This cool cat met his better half doing what life-saving activity?
Working as an EMT!
100
This chief is known for her elaborate dinner parties posted on instagram that no one is ever invited to. What is the name of the capital of her home country?
What is Cairo?
200
Whale if it isn't our suave new chief David Chu! You may know him for his kriller personality, but what state does he hail from?
What is California?
200
This badass chief is known for her clinical prowess and prompt email responses, but fewer people know that she has an instagram account dedicated to what Italian dish?
What is chicken parm?
200
Category: Geography
Name 3 of the top 5 most populous cities
Tokyo, Japan (37,400,068)
Delhi, India (28,514,000)
Shanghai, China(25,582,000)
São Paulo Brazil (21,650,000)
Mexico City (21,581,000)
200
Name three drug classes indicated in the treatment of afib with RVR
CCB, BB, Amiodarone
200
A 25 year old presents with drop syncope while riding a bike. What is shown in the echo below and what is the diagnosis?
What is dynamic outflow tract obstruction, HOCM?
300
This EKG is associated with a mutation in what type cardiac structure?
What is a sodium channel?
[Brugada]
300
What is the MOST SENSITIVE sign of the condition shown below?
What is systolic RA collapse?
The RA pressure during systole is lower than that of the RV in diastole, so systolic RA collapse is therefore the earliest echocardiographic sign of tamponade
300
What is the most common ABNORMAL finding on CXR in acute pulmonary embolism?
What is atelectasis?
300
What medication should be avoided in this patient?
Nitro
(Inferior MI with RV involvement)
300
A patient presents with chest pain, and a diagnosis is made, the name of which hails from the image below.
What is Takotsubo cardiomyopathy?
400
Define this rhythm and name the medication most commonly associated with this dysrhythmia
What is biventricular tachycardia, digoxin?
- In the example, you can see the QRS axis shifts 180 degrees from left to right with each alternate beat
- Another possible pattern is alternating left and right bundle-branch block
400
A patient with CAD, HLD, DM presents with crushing substernal chest pain. STEMI is activated based on v1-v3 ST elevations with reciprocal changes. What complication of acute MI is shown below?
What is ventricular septal rupture?
400
Category: Wordplay
This nine-letter adjective can mean both showing great intelligence and shining brightly.
what is Brilliant?
400
Category: Children's Literature
In 1937 his sister said he had “hats of every description,” which he would use as a “foundation of his next book.”
Who is Dr. Seuss?
400
The patient below is intubated for hypoxia and weighs 60kg--what is their appropriate initial tidal volume?
360cc (6cc/kg) for ARDS LTV lung protective management
500
Category: Football Fanatics
In 2019, this public university attempted to trademark the word "the" for use on clothing and hats.
What is THE Ohio state university
500
Category: Out of this world
A beloved animated film character who was going to be called Lunar Larry became him, inspired by the name of a real person.
Who is buzz lightyear?
500
name that device!
What is an impella?
500
An EKG is obtained on a patient with abdominal pain and shown below. What finding is shown and are you concerned about digoxin toxicity?
This is the classic picture of digoxin effect, with “sagging” ST segments and T waves taking on the appearance of “Salvador Dali’s moustache“. It is NOT a sign of digoxin toxicity, but indicates digoxin therapy.
500
A 30 year old presents with drowsiness. Describe the key findings of the EKG shown below. What diagnosis does it suggest?
What is broad QRS complexes and a dominant R wave in aVR is strongly suggestive of poisoning with a sodium-channel blocking agent.
600
A 35 year old woman presents with progressive DOE for three months, has not sought medical care previously. She has no chest pain, no DVT/PE risk factors. She is visibly cyanotic with O2 sat of 80% on RA, RR 18, HR 68. Her physical exam is notable for peripheral cyanosis, finger clubbing, and a loud p2 is heard on physical exam. Her lungs are clear. Her EKG is shown below. What is the diagnosis?
What is Eisenmenger's Syndrome?
V1 with tall R indicating severe RVH, and the repolarization changes of RVH in leads II, III, aVF, and V1 to V5 are more marked.
Also e/o bi-atrial enlargement (V1, II)
600
What is shown in the echo clip below?
What is an impella?
600
A patient presents with hypoxia, SOB. CXR is obtained and shown below.
A procedure is performed. The pt initially improves, then becomes progressively hypoxic. Repeat CXR is obtained. What finding is shown below?
What is a hydropneumothorax?
- Any time you see a horizontal fluid level, it means that there is air and fluid in the pleural space!
600
What is the mechanism of action of TPA?
it catalyzes the conversion of plasminogen to plasmin, the major enzyme responsible for clot breakdown.
600
Category: Natural Wonders
In December 2020 an international agreement added nearly 3 feet to this; one surveyor lost half a toe to frostbite in the effort.
What is Mount Everest?