Basic *insert expletive*
MAP Quest
Princeton Students are Smart!
Princeton Presents...
Final Jeopardy
100
This ECG finding is classically associated with hypocalcemia.
What is a prolonged QT interval?
100
This pulmonary complication was more common with greater fluid administration in ARISE FLUIDS trial.
What is Pulmonary edema?
Explanation: Pulmonary edema occurred in 5.0% of the higher-fluid group versus 0.6% of the restricted-fluid/early-vasopressor group. This provides a clinically intuitive example of the potential downside of additional fluid even though the trial's primary outcome was neutral.
100
A 73-year-old man is evaluated in the emergency department after an unwitnessed syncopal event. He recalls feeling a sensation of warmth and generalized weakness before the event but no chest pain, dyspnea, or palpitations. Medical history is significant for hypertension and dyslipidemia. Medications are lisinopril, hydrochlorothiazide, and atorvastatin.
Vital signs and screening cardiovascular and neurologic examinations are normal.
Which of the following tests should be included in the initial evaluation of this patient?
A. Ambulatory ECG monitoring and echocardiography
B. B-type natriuretic peptide and cardiac enzyme measurement
C. Magnetic resonance carotid angiography and MRI of the brain
D. Orthostatic blood pressure measurement and ECG
D. Orthostatic blood pressure measurement and ECG
Everyone gets an H&P, EKG, and orthostats
100
Name four props utilized during Grand Rounds this week
Swords, a blender, puffy shirts, weird hats, solo cups, wine glasses, fake whiskey ... among others
100
200
This enzyme is inhibited by acetazolamide.
What is carbonic anhydrase?
Inhibiting carbonic anhydrase impairs the conversion of HCO₃⁻ + H⁺ ↔ CO₂ + H₂O, reducing proximal bicarbonate reabsorption.
200
What curve explains why additional fluid eventually stops increasing cardiac output?
What is the Frank-Starling curve?
Explanation: On the steep portion of the curve, increasing preload substantially increases stroke volume. Once the ventricle reaches the flatter portion, additional preload produces little additional cardiac output but can substantially increase filling pressures and edema.
200
Three clinical criteria associated with the following EKG finding would be diagnostic of this syndrome, named by a family of cardiologists.
Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave. Must be associated with one of the following clinical criteria to make the diagnosis:
•Documented ventricular fibrillation (VF) or polymorphic ventricular tachycardia (VT).
•Family history of sudden cardiac death at <45 years old
•Coved-type ECGs in family members.
•Inducibility of VT with programmed electrical stimulation
•Syncope
•Nocturnal agonal respiration
Pedro Brugada and Josep Brugada are renowned Spanish cardiologists that co-discovered Brugada syndrome in 1992.
(Their brother Ramon Brugada later helped characterize the genetic aspects of the condition, which is frequently tied to mutations in the SCN5A gene)
200
A medical warning was given to the audiance before the play. What was it for?
Seizure warning, strobe light
300
Convert this VBG to an approximate ABG: pH 7.30, pCO₂ 28 mmHg.
What is pH ~7.35 and pCO₂ ~23 mmHg?
Arterial pH is typically ~0.03–0.05 higher than venous pH, while arterial pCO₂ is typically ~3–6 mmHg lower than venous pCO₂.
300
This physical exam maneuver can help determine whether a patient with septic shock is likely to respond to IV fluids.
What is a passive leg raise.
Explanation: Raising the legs to about 45° transiently shifts roughly 250–350 mL of venous blood from the legs and splanchnic circulation toward the heart, essentially creating a reversible “autotransfusion.” If this increase in preload produces a meaningful increase in stroke volume or cardiac output, the patient is likely fluid responsive. The effect occurs within about a minute and disappears when the legs are lowered, allowing you to test the potential benefit of fluids without actually giving them.
300
While most patients have mixed type, these are the two functional subtypes of vasovagal syncope
What are Vasodepressor Type and Cardioinhibitory Type?
300
What were the names of the two main characters in the play?
Philippe and Rene Descartes
400
This is the mechanism by which alkalosis affects ionized calcium.
What is increased albumin binding of calcium due to less H⁺ bound to albumin?
400
A patient with septic shock has a ScvO₂ of 82% despite worsening lactate and multiorgan failure. What pathophysiologic process can explain this paradoxically high venous oxygen saturation?
What is Impaired oxygen extraction?
Explanation: A high ScvO₂ does not necessarily mean tissues are adequately oxygenated. In severe sepsis, microcirculatory dysfunction and impaired cellular oxygen utilization can prevent tissues from extracting delivered oxygen effectively. Less oxygen is removed from the blood, so venous oxygen saturation can remain unusually high despite inadequate tissue oxygen utilization and severe illness.
400
TWO PART QUESTION!
23-year-old woman is evaluated for recurrent episodes of exertional syncope. She is otherwise well and takes no medications.
Which of the following is the most likely diagnosis?
A. Brugada syndrome
B. Hypertrophic cardiomyopathy
C. Long QT syndrome.
D. Neurocardiogenic syncope
----
and this is the management
C. Long QT syndrome.
medication check
electrolyte check (K+)
genetic testing
nonselective beta blocker
antiarrhythmics/Mexiletine
AICD / Left cardiac sympathetic denervation
refer to EP
400
The piano player in the play was acted by a princeton staff member. What is his normal 9-5 job?
Chaplain!
500
This syndrome is caused by a gain-of-function mutation in the ENaC channel.
What is Liddle syndrome?
Liddle syndrome mimics hyperaldosteronism, causing hypertension, hypokalemia, and metabolic alkalosis, but with low renin and low aldosterone levels.
500
This randomization technique, as used in the ARISE trial, assigns participants in small groups to ensure roughly equal numbers are allocated to each treatment arm throughout enrollment
What is Randomized blocks?
Explanation: Participants are randomized within predefined blocks—for example, a block of four might contain two assignments to each treatment group in a random order. This maintains balance in group sizes throughout the trial rather than relying on simple randomization to eventually produce similarly sized groups.
500
These two interventions can be used as part of the management plan for a subtype of recurrent, refractory vasovagal syncope
(but the evidence isn't great and there is a lot of expert opinion and shared-decision-making that would need to occur)
Pacemaker
Cardioneuroablation
500
Fill in the blank for this famous quote:
Common sense is the best distributed __________ ___ ___ _______, for every man is convinced that he is well supplied with it"
(bonus $300 if you can name the treatise in which it was written)
"Common sense is the best distributed commodity in the world, for every man is convinced that he is well supplied with it"
Discourse on the Method, 1637
René Descartes