Don't break my heart
Pick your poison
Creepy Crawlies
Witch's Stew
Halloween Trivia
200
Suspect the following in a patient endocarditis, heart failure and new onset heart block
Paravalvular absess
200
A feared complication of ingestion of this toxic alcohol is blindness due to retinal toxicity. Labs will show an elevated osmolar gap and a high anion gap metabolic acidosis
Methanol
*Treat with fomepizole
200
Suspect bites from this household nuisance in a patient with these painless but pruritic skin lesions that appeared after staying in a dirty budget motel
Beg Bugs (accept Cimex lectularius)
Treatment: eradication of furniture, wash sheets on high heat, hire exterminator
200
Complex pulmonary hypersensitivity reaction seen almost exclusively in patients with asthma or cystic fibrosis that can lead to chronic bronchiectasis and eventual fibrosis if untreated
Allergic bronchopulmonary aspergillosis
*Treatment: corticosteroids + itraconazole
200
Is a pumpkin a fruit or vegetable?
Fruit
400
Most common underlying risk factor for endocarditis
Structural Heart Disease
*75% of cases!
**Includes rheumatic heart disease, degenerative valvular lesions, aortic valve disease, congenital heart disease
400
Suspect ingestion of this toxic alcohol in a patient presenting with confusion, a high osmolar gap, a negative anion gap and no acidosis
Isopropyl alcohol
*Only toxic alcohol with no anion gap or acidosis
400
Arthropod borne viral infection associated with fevers, frontal headache, retro-orbital pain, myalgias and severe lumbosacral pain. Severe cases can progress to hemorrhagic shock with multi organ failure. Treatment is supportive
Dengue fever
*Termed "break bone fever"
400
Consider this "must not miss" diagnosis in a patient receiving chemotherapy who presents with neutropenic fever and abdominal pain.
Neutropenic Enterocolitis (accept Typhlitis)
*Diagnosis: Contrast abdominal CT
**Empiric tx: Zosyn or Cefepime and flagyl
***Can progress to bowel perforation and death
400
Term for a male witch
A warlock
600
Name this rhythm
Multifocal atrial tachycardia
*Rapid irregular rhythm > 100 bpm with at least 3 distinctive P-wave morphologies
600
Suspect toxicity of this substance in a patient with confusion, blurring and yellowing of vision, vomiting and this EKG:
Digoxin toxicity (accept dig toxicity, cardiac glycoside toxicity)
*Treat with Dig specific ab, HD if not effective
600
Infection with this gram negative pleomorphic bacteria can occur worldwide, with clinical presentation including fever, headache, malaise, arthralgia conjunctivitis, and pharyngitis often accompanied by a maculopapular, vesicular, or petechial rash. It is transmitted via fleas, mites, lice and ticks. Pathogenesis is related to microvascular permeability causing vasculitic appearing skin lesions. Tick borne illness from this pathogen in the US causes Rocky Mountain spotted fever
Rickettsial infections
*Treatment: Doxycycline for 7-10 days
600
Suspect this culprit class of medications in a patient with chronic osteoarthritis related pain and treatment resistant hypertension
NSAIDs
600
This country celebrates the Day of the Dead
Mexico
800
Name this rhythm
Wandering Atrial Pacemaker
*Same as MAT with rate <100
800
Suspect this diagnosis in a patient that becomes cyanotic after receiving local lidocaine during a minimally invasive procedure
Methemoglobinemia
*Occurs from exposure to oxidizing substances (dapsone, nitrites, local/topical anesthetics). Patient becomes cyanotic pulse ox ~85% and dark chocolate covered blood. Normal PaO2 on ABG. Treat with methylene blue!
800
This illness transmitted via the lone star tick causes fever, myalgias and headaches. It can cause a nonspecific rash in 30% of adults. Basophilic inclusion bodies can be seen in monocytes on peripheral smear as shown below:
Erlichiosis
*Anaplasmosis is very similar, however inclusions are seen in GRANULOCYTES and rash is rare.
**Tx both with doxy
800
Rare cystic lung disease seen in women in their 30s – 40s and associated with spontaneous pneumothorax and chylous effusions.
Lymphangiomyomatosis (LAM)
800
This famous magician died on Halloween in 1926
Harry Houdini (accept Houdini)
1000
Rare disease characterized by biventricular enlargement, refractory ventricular arrhythmias, and rapid progression to cardiogenic shock in young to middle-aged adults. Histologic examination demonstrates the presence of multinucleated giant cells in the myocardium.
Giant Cell Myocarditis
*Treatment immunosuppressants and/or LVAD placement or cardiac transplantation
1000
Suspect this culprit medication in a patient with hyperosmolar hypernatremia whose urine osmolality does not increase with desmopressin (DDAVP)
Lithium!
*Treat with lithium discontinuation. Amiloride or thiazide diuretics if cannot d/c lithium
1000
Suspect this infection in a homeless elderly patient with untreated HIV who often sleeps in very crowded shelters and has these hand findings:
Crusted scabies (accept scabies)
*Crusted variant is highly contagious and causes thick, concrete scales, it is seen in immunocompromised patients.
1000
This rare genetic syndrome presents with ventricular ectopy and monomorphic VT heart failure. Cardiac MRI shows enlargement, focal aneurysms and hypokinesis of the right ventricle.
Arrhythmogenic right ventricular dysplasia
*Patients should abstain from vigorous exercise.
**Tx: beta blockers, ICD to prevent SCD, antiarrythmics, catheter ablation
1000
The first jack o'lantern was carved from which vegetable?
A Turnip