Symptom Clusters
An elderly post-op patient develops sudden confusion, hypoxemia, and hypotension. Chest x-ray shows new infiltrates. What is the most likely cause?
What is post-op pneumonia/sepsis?
A 24 year old presents with syncope and palpitations. ECG shows prolonged QT interval. What lab test should you order first?
What is a BMP/CMP (check electrolytes: potassium, magnesium, calcium)?
A patient hospitalized with diabetic ketoacidosis has the following labs: pH 7.10, HCO3 10, anion gap 24. What is your interpretation?
What is a high anion gap metabolic acidosis?
Patient presents with fever, chills, hypotension, and purulent urine. Labs show WBC 20,000, lactate 4. What are your next steps?
What is sepsis bundle: blood cultures, IV fluids, broad-spectrum antibiotics, +/- pressors
A patient admitted was admitted three days ago for community-acquired pneumonia. On rounds the patient is afebrile, oxygenating well on 2L nasal cannula, and WBC is improving. A CXR was performed last night and still shows some consolidation. The patient is currently receiving azithromycin and ceftriaxone. What is your next step?
What is continue current management?
Patient with epigastric pain, vomiting, hypotension, and has an elevated amylase and the lipase level is three times the limit of normal. Hct is dropping. What is the most likely diagnosis?
What is pancreatitis?
Patient has sudden onset SOB, chest pain, tachycardia, and leg swelling. ECG shows S1Q3T3. Next diagnostic step?
What is CT pulmonary angiogram
Patient has fatigue and pallor. Labs reveal Hgb 9.5, MCV 70, ferritin 8, TIBC 500 (nl: 250-400). What is your interpretation?
What is iron deficiency anemia?
A patient with PMH+ heart failure presents with severe dyspnea, hypertension, and pulmonary edema. Oxygen saturation is 86%. What are two important steps in management?
What are noninvasive positive pressure ventilation (e.g., BiPAP) and loop diuretics?
While rounding in CCU, the nurse notifies you that your patient who is s/p CABG x 2, hospital day 2 is reporting chest pain. On exam, you note hypotension, muffled heart sounds, and distended neck veins. Bedside echo demonstrates a pericardial effusion. What is the immediate management?
What is OR take back for pericardial window?
A middle aged adult presents with sudden, severe epigastric pain, hematemesis and hypotension. Medication review reveals a history of NSAID use. Most likely diagnosis?
What is acute GI bleed from a perforated peptic ulcer?
Patient presents with acute-onset, severe right lower quadrant pain, rebound tenderness, mild fever, and leukocytosis. POCUS is inconclusive. Next diagnostic step?
What is CT abdomen/pelvis?
Patient reports severe substernal chest pain radiating to jaw, nausea, and diaphoresis. EKG shows ST elevation in leads II, III, aVF. Diagnosis?
What is an inferior MI?
A patient is admitted for diabetic ketoacidosis (DKA). Labs reveal show glucose 400, potassium 3.1, pH 7.30. What is the most important factor in management at this time?
What is potassium replacement prior to insulin initiation?
An 18-year-old admitted for DKA (glucose 450 mg/dL) is on an insulin drip. Labs: Na 136, K 4.2. What labs and monitoring do you prioritize?
What is monitor BMP (especially K), fingerstick glucose q1–2h, adequate hydration, and adjust insulin drip per protocol?
A patient presents to the ED after missing two dialysis sessions and complains of dyspnea and orthopnea. Exam reveals bilateral crackles and hypertension. Diagnosis?
What is acute pulmonary edema due to volume overload?
A 62 year old woman presents with fatigue, pallor, and mild shortness of breath on exertion. Labs reveal Hgb 9.9, Hct 29.7, MCV 70. She denies frank bleeding. What is the next step in diagnosis?
What is EGD/colonoscopy?
A 48 y/o woman with lupus on chronic prednisone develops moon facies and proximal muscle weakness. Labs show suppressed ACTH and low endogenous serum cortisol. What is your interpretation?
What is exogenous (iatrogenic) Cushing syndrome?
A patient with ESRD is admitted for volume overload due to missed dialysis. When ordering DVT prophylaxis, what is the preferred pharmacologic agent?
What is heparin?
You are rounding on a 65-year-old with HFrEF admitted for ADHF. Vitals: BP 130/78, HR 98, SpO₂ 92% on 2L NC. The patient has been on double their home dose of furosemide while inpatient. What do you evaluate on rounds?
What are volume status, urine output, daily weights, electrolytes, renal function?
A patient s/p MI develops sudden dyspnea, hypotension, and harsh systolic murmur at the apex. Diagnosis?
What is acute mitral regurgitation secondary to papillary muscle rupture?
Patient presents with acute onset right upper quadrant pain, fever, and jaundice. Labs: AST/ALT mildly elevated, ALP and bilirubin elevated. Imaging shows gallstones in common bile duct. What is the next step and WHY?
What is endoscopic retrograde cholangiopancreatography (ERCP) for stone removal? *ERCP can be diagnostic and therapeutic.
A patient who presented to the ED has the following ABG: pH 7.48, PaCO2 30, HCO3 22. What is your interpretation of the primary disturbance AND what condition is likely present?
What are respiratory alkalosis and pulmonary embolism?
A 72-year-old patient with chronic kidney disease presents with sudden shortness of breath, hypoxemia, and hypotension. Chest X-ray shows clear lungs, and bedside echocardiogram reveals right ventricular dilation. What is the diagnosis AND what is the next step in management?
What is massive pulmonary embolism AND initiate systemic thrombolysis or emergent embolectomy?
You are rounding on a 45-year-old, POD 1 laparoscopic cholecystectomy. The patient is currently on clear liquids and vitals are as follows: BP 118/70, HR 88, Temp 99°F. Labs are WNL with exception of mildly elevated WBC of 11. What are five things that you need to assess during rounds?
What is assess pain control, bowel function, ability to tolerate clear liquids, wound status, and mobility?