The Great Suppression
SNF Happens
Poison Pearls
Uthought
Diagnose That Diva
100
Name 3 indications for long term PPI use.
What are
100
This type of Medicare plan often requires prior authorization before a patient can be placed in a skilled nursing facility.
What is Managed Medicare? (as opposed to Traditional Medicare)
100
This lab finding differentiates CCB overdose from BB overdose.
What is hyperglycemia?
100
This is the expected FEV1, FVC, FEV/FVC, TLC, and DLCO for a patient with ILD.
What is a restrictive pattern (low FEV, low FVC, low TLC, preserved FEV/FVC ratio, low DLCO).
100
Selena Gomez was diagnosed with this autoimmune disease associated with fatigue, arthritis, and possible renal involvement.
What is SLE?
200
Name 2 vitamins or minerals that have affected absorption due to PPIs.
What are magnesium, calcium, B12, and iron?
200
A patient must typically have this type and length of hospital stay to qualify for Medicare-covered SAR.
What is a qualifying inpatient hospital stay (3 inpatient midnights)?
200
Name 5 causes of AV block.
What are
Degenerative
Age-related conduction system fibrosis (Lenègre-Lev disease)
Ischemic
Acute MI (inferior → nodal block; anterior → infranodal block)
Chronic ischemic cardiomyopathy
Infiltrative/inflammatory
Sarcoidosis
Amyloidosis
Infectious
Lyme carditis
Viral myocarditis
Bacterial endocarditis (with perivalvular abscess)
Metabolic/endocrine
Hyperkalemia
Severe hypothyroidism
Congenital/genetic
Congenital heart disease
Genetic mutations (SCN5A mutation)
Neonatal lupus
Medications/toxins
Beta blockers
Calcium channel blockers
Digoxin
Class I/III antiarrhythmics
200
Name the classic pattern of thyroid studies seen in euthyroid sick syndrome with severe illness (T3, T4, TSH, rT3).
What is reduced T3 (earliest), reduced T4, reduced TSH, and increased rT3.
200
Billie Eilish was diagnosed with this nervous system disorder at age 11.
What is Tourette's syndrome?
300
This is the duration of high-dose PPI recommended as continuous or intermittent therapy after successful endoscopic hemostatic therapy of a bleeding ulcer.
What is 3 days?
high dose is ≥80 mg daily
ACG recommendation with high quality evidence
300
This insurance program is the primary payer for long-term care (LTC).
What is Medicaid?
300
DAILY DOUBLE
Name all three first line therapies for hemodynamically significant CCB overdose.
What are IV calcium, high-dose insulin, and vasopressor (norepi)
300
Aneurysm of this artery is associated with a third nerve palsy, manifesting as a dilated pupil and loss of accomodation early in the process, followed by ptosis and opthalmoplegia late in the process.
What is the posterior communicating artery?
300
Angelina Jolie underwent cancer risk-reducing surgery at 39 years old after testing positive for a germline mutation in this tumor suppressor gene involved in homologous recombination repair.
What is BRCA1?
400
DAILY DOUBLE
Strong CYP219 inhibitors, including this PPI, should be avoided in patients on clopidogrel.
What is omeprazole/esomeprazole?
Clopidogrel is a prodrug that requires conversion to its active form by CYP219 metabolism.
Pantoprazole is the better choice due to weaker CYP219 inhibition.
PPI therapy dos not affect the efficacy of ticagrelor or prasugrel.
Patients on DAPT with elevated risk, including those with PUD, prior GIB, H. pylori infection, or age >65, should be started on PPI therapy.
400
Medicare Part A may cover up to this many days of skilled nursing facility care during a benefit period.
What is 100 days?
400
A 45-year-old presents with tinnitus, tachypnea, and diaphoresis. ABG shows pH 7.45, pCO₂ 20, HCO₃ 14. The is the acid-base disturbance, the likely toxin, and treatment.
What are mixed respiratory alkalosis and metabolic acidosis, salicylate (aspirin), and alkalinization (serum and urine: bicarb and acetazolamide)?
This mixed disturbance is often considered pathognomonic
400
A man develops painless blisters on the backs of his hands after sun exposure, he also has chronic hep C, this diagnosis should be suspected.
What is porphyria cutanea tarda?
400
Celine Dion has a rare neurologic disorder that causes painful muscle spasms and stiffness that affected her ability to perform.
Stiff person syndrome
500
3 months after starting a PPI for UGIB, your patient presents with subjective fevers, malaise, and a new found AKI. This is what you would anticipate finding on the urinalysis.
What are WBCs and WBC casts +/- mild RBCs, proteinuria, or eosinophils (40%)
Classic triad of fever, skin rash, and eosinophilia is rarely present
Tx is discontinue offending agent and glucocorticoids
500
For a hospice patient residing in a nursing facility, this party is responsible for covering room and board costs.
What is the patient (out-of-pocket) or Medicaid if eligible?
500
This is the immediate treatment for a 24-year-old who is brought in obtunded after an unwitnessed ingestion; an amitriptyline pill bottle is found. Pupils are 7 mm, skin is dry and flushed, bladder is distended. HR 128 sinus with a wide of QRS 168 ms. ABG pH 7.18. She has a witnessed generalized seizure that terminates in the ED.
What is sodium bicarbonate?
500
Name 3 dietary modifications to reduce the risk of the calcium based nephrolithiasis.
What are increase fluids (>2L), increase dietary Ca (supplement), decrease oxalate, increase citrate, decrease Na, decrease animal protein, increase potassium?
500
Venus Williams stepped back from tennis in 2011 after being diagnosed with this autoimmune disease, which carries a roughly 15- to 20-fold increased risk of B-cell lymphoma.
What is Sjogrens Syndrome?