The Heart Wants What It Wants
AI Takeover Part 2
The Numbers...What Do They Mean???
Board Certified Boards and Beyonder
Pokemon or Medication
100
Your patient with baaaaad PAD gets an ABI and it is > 1.4, why? What else can you measure?
Toe-Brachial Index
>1.4 in a PAD patient is indicative of calcified vessels that do not compress normally
100
What 3 specific tests should you order to diagnose AI? (Not talking about general labs likle CBC, CMP, etc)
AM Morning Cortisol, Plasma ACTH, and Cosyntropin Stimulation Test
100
What is the goal uric acid level when treating a patient for gout?
<6
100
What is the most appropriate management?
A. Bronchoscopy | B. Methylprednisolone | C. Nebulized epinephrine | D. NIPPV
Bronchoscopy
This patient sustained thermal injury to his upper airway as evidenced by symptoms of tracheal irritation, sore throat, dysphonia, and an edematous oropharynx. Intense heat can cause edema and blistering from the mouth to the larynx, and patients with a visibly damaged airway or stridor are at high risk of complete upper airway obstruction due to swelling. Following smoke inhalation, one third of patients develop airway edema or mucosal sloughing from epithelial necrosis
100
Aceon
Perindopril - ACEi
200
Name 3 characteristic EKG findings of VTach
Axis: Extreme Right Axis – 90% specific
Broad Complex: QRS >200ms – 85-90% specific
Concordance: Precordial leads – 97% specific
Dissociation: AV dissociation – Nearly 100% specific
Early part of QRS: RS interval > 100ms
200
What is the difference in outpatient management of Primary AI vs Central AI?
Both require HC, but only Primary AI needs fludrocortisone as well (need to replace aldosterone which is otherwise regulated by RAAS system in Central AI)
200
What is the hemoglobin threshold for transfusion in a patient with ACS?
10! Thanks Dr. Carson
200
A patient comes in to your clinic with a wart on their face! What is the firstline treatment?
Topical salicylic acid
Other areas can due excision, but this is often avoided on the face due to scarring
Other treatments include cryotherapy or laser treatment in general
200
Gliscor
Pokemon!
300
What lab test can rule out an acute aortic dissection?
D-Dimer; <500
Reflects activation of extrinsic pathway of coagulation cascaded by TF exposed in aortic media
300
Name 3 infections that can cause Primary AI
Neisseria Meningitidis, TB, histoplasma
Sepsis can also broadly cause it as well
300
What are the values of Valve Area, gradient, and Vmax that indicate severe aortic stenosis?
AVA <1 cm^2
Vmax >= 4m/s
Mean Gradient >= 40mmHg
300
Your gastric bypass patient comes to see you because they are experiencing palpitations, diaphoresis, tachycardia, and diarrhea 30 minutes after eating. What is the diagnosis and management?
Dumping Syndrome
Management is to eat smaller meals more frequently
This is different from gastroparesis as that does not have the vasomotor symptoms
300
Rozerom
Ramelteon - hypnotic
400
What is the Class I indication for Cardiac Resynchronization Therapy
LVEF ≤ 35%, LBBB with QRS duration ≥ 150ms, NYHA Class II to IV symptoms.
400
What is the recommended management for suspected Adrenal Crisis? Drug and dosing pls
Stress Dose steroids which is typically 100mg IV hydrocortisone bolus followed by 50-100mg HC q6h
Also needs IVF, sugar and elecrtolyte monitoring, etc
400
What is the platelet threshold and/or clinical factor that would necessitate treatment for a patient with ITP? What is the treatment?
<30k OR bleeding
Tx with IVIG or steroids
400
Your young patient has had randomly elevated urinary protien levels but has otherwise benign labs and no risk factors for kidney disease. What is the likely diagnosis and how do you diagnose?
Orthostatic Proteinuria
Dx with spot urine tests upon arising and at the end of the day
It is an otherwise harmless condition that is more common in children/adolescents that tends to disappear with age. It is related to altered glomerular hemodynamics and neurohormonal activation.
Typically have no increased risk of development of renal failure
400
Geodon
Ziprasidone - Atypical Antipsychotic
500
What is this sign called and what is it specifically concerning for?
Wellen's Sign, concerning for critical proximal blockage in the LAD
500
Immune Checkpoint Inhibitors (like tislelizumab) can cause Adrenal Insufficiency in what manner?
Direct Adrenal Toxicity (so it causes Primary AI) as opposed to HPA Axis Suppression (Secondary AI) in chronic steroids, opioids, etc
500
What EF range should you offer a patient with MR surgical repair?
30-60% (MR overestimates the EF)
>60% if symptomatic can also get surgery; otherwise q6-12 TTE
<30% is medical management (poor likelihood of improvement)
500
A 50 year old man living in Tennessee is evaluated for anaphylaxis. He was in his normal state of health until this evening when he noted the acute onset of hives, GI upset, and subsequent throat swelling leading to anaphylaxis. He was celebrating his birthday at Outback Steakhouse 4 hours prior but has never had any food allergies, other allergies or hx of anaphylaxis. He is an avid hunter and pulled a tick off of himself the other day. He has no other PMH, PSH, and does not take any medications. He is stabilized in the ICU with airway protection after treatment with epi.
What is the most likely diagnosis?
Alpha-Gal Syndrome
Acquired allergic reaction to meat, caused by tick bites from the Lone Star tick
500
Vibrava
Pokemon!