General Medicine
Hepatobiliary
Infectious Diseases
Cardiology
Heme/Onc
100
55yo female presents after an episode of “blacking out” at her sons college graduation. She felt a wave of nausea and began to sweat before it occurred. She did not experience any trauma and was back to baseline within minutes.
What is vasovagal syncope. Differentiate based on sx before, actions during and return to baseline.
100
These conditions give you LFTs over 1000s
What are fulminant hepatitis, Alpha-amanitin toxin from eating wild mushrooms, Tylenol, shock liver?
100
You admit a 22yo male for fevers, chills and lower extremity cellulitis, nurse calls you because he is complaining of increasing pain. You find decreased dorsal pulses on the affected leg.
What is compartment syndrome. Surgical emergency.
100
Transition from peaked hyperacute T waves, ST elevation, Q waves (significant Q wave = 1/3 amplitude QRS), and T wave inversion.
What are the three ECG changes seen in NSTEMI
100
50y/o M “meat-a-tarian” just finished 2wks of clindamycin has hemarthroses & oozing at venipuncture sites
What is VitK def. ↓ II, VII, IX and X. Same treatment for warfarin toxicity….Tx w/ FFP acutely + vitamin K shot
200
These two causes of secondary hypertension can be treated surgically
What are pheochromocytoma, renal artery stenosis or fibromuscular dysplasia Initial lab work HTN
200
DOUBLE JEOPARDY!!! Indications for Emergent Dialysis
• A-Acidosis • E-Electrolyte imbalance  particularly high K > 6.5 • I-Intoxication  particularly antifreeze, Li • O- Overload of volume sxs of CHF or pulmonary edema • U- Uremia  pericarditis, altered mental status • NOT for high creatinine or oliguria alone bc that's not emergent
200
Prophylaxis for contacts of patients with neisseria meningiditis.
What is a course of Rifampin 600mg PO BID for two days first line? Cipro or Ceftriaxone are equally as effective.
200
Atrial fibrillation management <48hrs
What is Rate control agents = Beta Blocker metoprolol or Ca Channel Blocker diltiazem Rhythm control agent like digoxin (L ventricular systolic dysfunction), amiodarone or procainamide CHAD2 score for anti coag and need TEE if >48hrs
200
Ab against the platelets which causes clearance and ACTIVATION leading to paradoxical thrombosis
What is HIT (Heparin Induced Thrombocytopenia)
300
Six bugs that cause bloody diarrhea.
What are E.coli (EHEC EIEC, E.coli O157 H7) Shigella: TMP SMX Salmonella: Never worsens Campylobacter, Yersinia (pseudoappendicitis), Entamoeba histolytica: Metro!! (liver abscess!) +/- c.diff: metro IV (why not PO?) and Vanco (PO)
300
Inflammatory bowel disease is associated with this hepatobiliary condition.
What is primary sclerosing cholangitis?
300
The reason to tap everyone in the ED with ascites.
What is the possibility of SBP? WBC > 500, PMN > 250. Positive culture.
300
Three main types of shock
What are Cardiogenic, hypovolemic and Distributive = neurogenic, anaphylactic and septic shock are examples Discuss Cardiac output, SVR, mixed venous return of oxygen, pulmonary wedge pressure
300
Lab tests to distinguish between DIC vs TPP, ITP.
What are PTT/PT time, d dimer, fibrinogen/fibrin levels
400
SBP is >180 or DBP is >120 with possible signs of... Neuro: Pulmonary: Heart: Kidney:
What is hypertensive emergency? Urgency is #s minus end organ damage. What would look for on physical exam? Neuro: papilledema, Cushing rxn, seizures, stroke Pulmonary: flash pulmonary edema Heart: MI with EKG/trops possible dissection Kidney: AKI
400
35 y/o female with hx of Graves, rheumatoid arthritis presents with jaundice and dark urine for 3 weeks. She has a 1-year history of generalized pruritus. She takes no medications. Examination shows jaundice and several ecchymoses over the forearms and thighs. The liver and spleen are enlarged and nontender. Most likely diagnosis and what lab test would we order to confirm?
What is primary biliary sclerosis? Antimitochondrial antibody assay is strongly positive. Ursodeoxycholic acid is the symptomatic treatment for this condition.
400
Infectious causes of adrenal insufficiency.
What are TB, cytomegalovirus, cryptococcus, toxoplasmosis, and pneumocystitis.
400
Most common cause of acute endocarditis.
What is Staphylococcus aureus? death in 6 weeks if untreated! HACEK group of organisms: Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella. Prosthetic valve S. epidermidis more common.
400
Pt w/ normal MCV, ↑LDH, ↑indirect bilirubin, ↓ haptoglobin with ...Sickle cell kid w/ sudden drop in Hct.
What is Aplastic Crisis, Sickle Crisis from hypoxia, dehydration or acidosis
500
You are treating a 75yo Hispanic male for influenza as an outpatient, after completing a 3 day course of tamiflu, he returns with worsening SOB, fevers and chills. You perform a thorough physical exam and hear decreased breath sounds in the right middle lobe, along with some crackles and egophony.
What is superimposed bacterial infection. You want to admit him to the hospital and start him on IV ABX. What's the bug?
500
An acute bacterial infection of the biliary tree that commonly occurs 2° to obstruction due to these two causes
What is Acute Cholangitis secondary to gallstones (choledocholithiasis) or 1° sclerosing cholangitis
500
Prophylaxis do we use to prevent ventilator associated pneumonia in our patients with ETT
What is Chlorhexidine rinse BID?
500
3 months post-NSTEMI pt presents with persistent ST elevation with deep Q waves but no enzymes present. The pt has new-onset systolic murmur described as blowing in the mid-clavicular region
What is Left ventricular aneurysm formation which causes mitral regurg?
500
Pt w/ normal MCV, ↑LDH, ↑indirect bilirubin, ↓ haptoglobin with ...Cyanosis of fingers, ears, nose with a recent Mycoplasma infection.
What is IgM cold agglutinin.
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