Intern Report Jeopardy

GI

100

Most common cause of acute cholecystitis

Cholelithiasis

200

Score used to assess if a patient with alcoholic hepatitis may benefit from steroids

Maddrey's Discriminant Function

300

When should enteral feeding be resumed for patients with acute pancreatitis?

EARLY (goal: within 24h)

400

Which is better to minimize risk of re-bleed for a high-risk peptic ulcer: Intermittent or continuous PPI?

Intermittent = noninferior (Sachar H et al 2014)

500

What pharmacologic treatment may used to treat Ogilvie's syndrome if conservative measures fail?

Neostigmine (acetylcholinesterase inhibitor)

Cardiology

100

Name this diabetes medication that reduces risk of mortality and hospitalization for heart failure

empagliflozin, dapagliflozin, canagliflozin (SGLT2is)

200

What 4 classes of meds comprise HFrEF GDMT?

Beta blocker

ACE/ARB/ARNI

MRA

SGLT2i

300

True or false: Swan Ganz catheters are associated with survival benefit in critically ill patients

False - no confirmed survival benefit (but, controversial)

400

What is Wellen's sign? 

Biphasic t-waves in V2+V3

OR
Deep inverted t-waves in V2+V3

Usually present in pain-free state
Sign of critical LAD stenosis

500

What is McConnell's sign?

RV free wall akinesis with sparing of apex (apex ~ trampoline)

Low sensitivity, high specificity for PE

Can also occur w RCA infarct 

Nephrology

100

Most common cause of AKI in the hospital

Acute tubular necrosis (ATN)

200

Name an indication for urgent/emergent dialysis

A -- acidemia

E -- elecytrolytes (ex: mg, k)

I -- intoxication (ex: ethylene glycol, methanol, lithium, salicylate)

O -- overload 

U -- uremia 

300

Which type of vascular access is preferred for CRRT?

Catheter (AV fistula or graft generally contra-indicated d/t risk of damage, bleed, and because w lower pressures for CRRT, vessels would collapse)

400

After which type of renal injury may patients start "auto-diuresing?"

Post-ATN diuresis (large volume loss of dilute fluid - may become hypernatremic)

500

Name a risk factor for osmotic demyelination syndrome

Chronic hyponatremia (present for >2-3d)

Severe hyponatremia (<120)

Overly rapid correction of hyponatremia (has been documented w as low as +8 meQ/24h)

Heavy EtOH use

Malnutrition

Liver disease

Hypokalemia

Toxicology

100

Medication for opioid overdose

Narcan

IV/IM: initial dose 0.2-0.4mg 

inh: 2mg

200

Name at least 2 signs/symptoms of alcohol withdrawal

nausea, vomiting, hallucinations, headache, tremor, sweats, tachycardia, anxiety, agitation, disorientation

300

Medication that can treat BZD overdose

Flumazenil

400

Medication that may be used to treat serotonin syndrome?

Cyproheptadine (often, patients just managed supportively)

500

Medication that may treat malignant hyperthermia?

Dantrolene

(in addition to cooling, supportive care, and stopping offending med -- often anesthetics like halothane or isoflurane, or paralytic like succinylcholine)

ACLS

100

What medications might you reach for in a hemodynamically stable patient with Afib with RVR, without underlying heart failure? 

Metoprolol, Diltiazem

200

Which medication (and dose) would you push for symptomatic bradycardia?

Atropine 1mg

(Can give q3-5min, max 3mg)

300

Which medication (and dose) would you push for narrow complex regular tachycardia, if vagal maneuvers have been ineffective?

Adenosine 6mg (if first dose ineffective, repeat with 12mg)

400

For witnessed VF/VT arrest, when in algorithm should first shock be administered?

As soon as possible

500

What is the primary indication for epinephrine during resuscitation for cardiac arrest?

Improve venous return to R heart