Potpourri
Random Numbers
Hemodynamics
Radiology
Who Knew Wash U?
Antenatal Ultrasound Findings
Congenital Infections
100
A newborn male has prolonged bleeding after a circumcision. Laboratory evaluation shows
Hgb 12, platelets 225, PT 15, INR 0.98, PTT 98
These are the most likely diagnoses and biologic causes.
What is hemophilia A (Factor VIII deficiency) and hemophilia B (Factor IX deficiency)?
100
A 35 week infant has RDS with pulmonary hypertension.
HFOV settings:
MAP 17 amplitude 36 hertz 10 FiO2 0.9 iNO 20ppm
ABG: 7.39/38/56/23
Calculate his Oxygenation Index.
OI=(MAP xx FiO2 xx 100)/(Pa02)
What is 27.3?
100
Inotrope milrinone PGE3 = no lactic acidosis?
Disadvantage of dopa - PH
shunts and Qp:Qs
echo findings (atr L->R, PDA R->L)
What is 15-20%?
(increases with advancing gestational age)
100
Describe the radiographic findings.
What is Pneumopericardium?
100
This 1991 graduate of Wash U School of Arts and Sciences, physician-scientist is the former director of the Center for Disease Control (CDC) and Prevention (2021-23).
Bonus: What is the graduate's area of scientific/medical expertise?
Who is Rochelle Wolensky, CDC director from 2021-2023?
Bonus - Area of expertise: HIV/AIDS
100
A fetal anatomy scan is shown below.
Name 2 common diagnoses associated with this finding.
What is increased nuchal translucency?
What are Trisomy 21, also 18 and 13, Turner syndrome, Triploidy?
100
This infection has lead to a 34 week fetus having new onset decreased fetal movement, pleural effusions and elevated MCA dopplers.
Bonus: these hematologic parameters may be affected.
What is Parvovirus B19?
What are Hgb/Hct and retic count?
200
Areas of the brain that are most commonly injured in hypoxic ischemic encephalopathy.
What are the basal ganglia, thalamus, and deep nuclear grey areas?
200
A study has a 90% likelihood of not rejecting the null hypothesis when it's actually false.
Name this type of error.
What is Type II error?
200
The rhythm strip from infant born to mother with SLE
is due to this diagnosis, this pathologic process, and has this long-term prognosis.
What is prolonged PR interval, type I heart block (can range 1st-3rd degree, in utero presentation typically 2nd-3rd)?
What are Anti-Rho/SSA, anti-La/SSB antibodies?
What are irreversible changes to conducting system?
200
Describe the brain findings on the image.
Name the most common genetic cause of this condition.
What is Lissencephaly?
What is the LIS1 gene?
200
This actor who graduated from Wash U in 1993 often plays movie villains, including Hector Hammond in Green Lantern.
Bonus: Name where the actor was born.
Who is Peter Sarsgaard?
Where is Scott Air Force Base?
200
A level 2 fetal ultrasound shows mediastinal shift as seen below.
Name what is causing the shift and what index
is used to prognosticate the risk of hydrops fetalis.
What is a Congenital Pulmonary Airway Malformation (CPAM)?
What is a CPAM Volume Ratio (CVR)?
>1.6 increases risk of hydrops
200
This vaccine preventable disease can lead to a blueberry muffin rash at birth.
BONUS: Name other manifestations can be present as well.
Enterovirus
Rubella
CMV
Zika?
Syphilis
What is congenital rubella syndrome?
What are cataracts, PDA, deafness, hepatosplenomegaly, meningoenphalitis?
300
A 4.2 kg IDM infant has a Hct of 72% and blood is noted in his urine.
Name the diagnosis and the 2 other findings associated with this diagnosis.
What is renal vein thrombosis?
What is flank mass and thrombocytopenia?
300
An 6 week old infant with a large VSD has slow onset tachypneic at rest.
Cardiac cath shows:
pulmonary venous saturation 100%
pulmonary arterial saturation 88 %
SpO2 94%
SvO2 54%
This is his Qp/Qs ratio:
Q_P / Q_S = (S_pO_2 - S_vO_2)/(P_vO_2 - P_aO_2)
= (94-54)/(100-88)
= 2.5:1
300
These fetal cardiac conditions are most commonly associated with hydrops.
What are:
Ebstein's anomaly
Tetralogy of Fallot with Absent Pulmonary Valve
SVT
Fetal heart block
300
An infant with this syndrome has episodic hyperpnea, abnormal eye movements and hypotonia and this brain MRI finding.
What is Joubert Syndrome?
Caused by >35 genes
300
This scientist and WashU Professor in 1947 became the first American woman to win the Nobel Prize in physiology of medicine for her work on glycogen metabolism.
Bonus: Name the location where her Nobel Prize is displayed.
Who is Gerty Cori?
Where is Becker library?
300
A 2nd trimester fetal ultrasound is shown below. This finding persisted on repeat ultrasound 3 weeks later.
Name the finding and 2 diagnoses associated with this finding.
What is Echogenic bowel?
What are:
Trisomy 21, especially with other findings
CMV/Toxoplasmosis
Cystic fibrosis
IUGR
GI malformation
300
While typically neonatal onset, this congenital infection can cause the skin findings below.
Whatis Intrauterine HSV infection?
<5% of HSV infections
400
Omphalocele and gastroschisis are abnormalities in the development of this specific part of the body.
What is the midgut?
400
A 500 gram infant 23 week infant has a sodium of 150 on DOL 2. This is his free water deficit.
= (Na_(current)-Na_(goal))/(Na_(goal)) xx TBW
= (Na_(current)-Na_(goal))/(Na_(goal)) xx 0.90 xx 0.5kg
= 0.032 L = 32 mL = 64 mL//kg
400
A transport referral is concerned about severe pulmonary hypertension in a 2 hour old term infant. They wants to know if there is an echocardiographic finding in which you would not start iNO.
Describe two potential findings (in detail)
What is Evidence of LV failure - PDA R->L, atrial level L->R?
What is TAPVR?
400
An infant with this syndrome presents with respiratory failure, hypotonia, seizures and radiograph below.
Name the finding and diagnosis.
What is epiphyseal stippling?
What is Zellwegger Syndrome?
Peroxisomal disorder
AR, PEX6 gene
400
This 1966 graduate of the WashU School of Arts & Science co-wrote and/or co-directed Caddyshack, National Lampoon’s Vacation, Stripes, Animal House & Ghost Busters.
Who is Harold Ramis?
400
A community OB consults MFM due to the concerning finding below on limb ultrasound.
Name the disease process and one of the most common gene involved.
What is Osteogenesis imperfecta?
What are COL1A1 and COL1A2?
400
This congenital infection can be asymptomatic at birth but can cause osteochondritis, peeling skin on the hands and feet, and other abnormalities.
Bonus 1: name the specific treatment for this in neonates.
Bonus 2: identify all parts of the neonatal evaluation of this infection.
What is syphilis?
What is penicillin G - 50,000 units/kg/dose IV every 12 hours during the first 7 days of life and every 8 hours thereafter for a total of 10 days ?
What are serum RPR, CSF exam including VDRL, CBC, AST/ALT, long bone radiographs, hearing screen?
500
A 2 day old 24-week infant is receiving TPN through a UVC and 160 Na acetate through the UAC. The infant has narrow pulse pressure, tachycardia, weak pulses, poor cap refill and muffled heart sounds.
Name the diagnosis and the catheter most responsible.
What is a pericardial effusion with tamponade physiology?
What is the UVC?
500
Specificity is a property of a test determined by this ratio.
"Specificity" = "True negatives" / ("True Negatives" + "False Positives")
500
A term infant is born to a mom without prenatal care. He has severe respiratory distress and is intubated in the delivery room and receives 100% FiO2 to maintain SpO2 in the 90%s.
Echocardiogram shows RVp 90 mmHg, flat IVS, RV dilitation, decreased RV systolic function, and increased SVC flow.
Identify the cause of this babies cardiopulmonary issue.
Identify an exam finding that could help make the diagnosis.
What is Vein of Galen Malformation?
What is auscultation of the anterior fontanelle?
500
An abdominal mass in a term infant is evaluated with MRI and shows this diagnosis.
What is Fetus in fetu?
500
This 1987 graduate of WashU School of Engineering founded Square, an e-payment company.
Bonus 1: Name his business partner in founding Square.
Bonus 2: This is the new name of Square.
Bonus 3: Name the other company his business partner founded.
Who is Jim McKelvey?
Who is Jack Dorsey?
What is Block?
What is Twitter?
500
The following ultrasound was obtained in the 2nd trimester.
Name this finding and name the overarching CNS finding is it associated with.
What is Proboscis (Ethmocephaly)?
What is Alobar holoprosencephaly?
500
A term newborn has microcephaly, hydrocephalus, chorioretinitis and hepatosplenomegaly. Head ultrasound shows calcifications.
Name the infectious organism
Bonus: name the location of the calcifications
Bonus: this intermediate animal is often involved
What is congenital toxoplasmosis (infection with Toxoplasma gondii)?
What are diffuse calcifications?
What is a cat?
