Things are getting out of hand here!
For 100 points, a patient presents with light-headedness, palpitations, and an irregular heart rate. On EKG, HR is 160, a fib with RVR, and BP pressure is 75/30. What is the correct intervention?
+/- a TEE and synchronized cardioversion
Bonus: If it were planned, what are the anticoagulation recommendations?
Your patient's eGFR is 45 on their routine visit. What is the next step?
Chart review/ serial eGFRs, Urine albumin-to-creatinine ratio, Look for reversible causes (BMP, CBC, urinalysis)
Your female patient with newly diagnosed afib has a CHA2DS2-VASc score of 4. What should be started?
OAC
What ACSVD score would you start a high-intensity statin?
>20%
Your patient has known PAD and presents to the office with complaints of increased pain. What would prompt you to consult a vascular surgeon?
What is rest pain, loss of distal pulses, gangrene, or evidence of wound with impaired healing, and an ABI <0.4
Your patient is here for their annual check-up. Their BP is 145/82 what is the next step?
Have them start with at-home BP monitoring and follow up
Your patient with stable angina is on a beta blocker and reports still having chest pain with exertion. What are the next medical options if their BP is stable?
DHP CCB (Amlodipine) or long-acting nitrates like Isosorbide dinitrate or isosorbide mononitrate
What CHADsVASC score would prompt you to recommend OAC, but is not mandated?
CHA₂DS₂-VASc scores of 1 in men and 2 in women
Your patient with known stage 3 CKD on an ACEi and SGLTi labs come back with the following values: Na 135, K+ 6.8m, CL 105, Bicab 12, BUN 150, Cr 7.8, and a Hgb of 8.2. What are the next steps and why?
STAT nephrology consult
Dialysis (potassium, BUN)Bicarb replacement bicarb < 18
Erythroprotien stimulating agent
Your patient comes in with chest pain that goes away with rest, their pretest probability is >15%. What is the next step?
Your patient recently had a minor stroke, NIHSS of 2, and it was not from a cardioembolic source. What medications should be started?
DAPT for 21 days.
Bonus: What are the preferred medications and doses?
Your patient's LDL is 195. What should you do?
Start a high intensity statin
A patient presents to the ED after their partner called EMS when they all of a sudden could not talk, lost the ability to use their right arm, and when asked to smile, half of their face was paralyzed. It has been 1.5 hours since symptom onset. The CT head was complete and looked normal, blood glucose was 90? What medication should this patient get, and what would be a contraindication to it?
This patient qualifies for TNK/ TPA
Contraindications are
Active internal bleeding
Severe uncontrolled hypertension >180/110
History of cerebrovascular accident
History of aneurysm or arteriovenous malformation
History of intracranial neoplasm
Intracranial or intraspinal surgery within the last 2 months
Head or spinal trauma within the previous 2 months
Conditions that increase the risk of bleeding
Bonus question what is the dose?
Your patient reports dizziness and palpitations intermittently. They are NSR on the EKG done in the office. What is the next step?
Ambulatory electrocardiogram
Your patient was admitted for a stroke, they initially received TNK. On their MRI, you see cortical bilateral multifocal hyperdensities. What will be the secondary prevention for this patient?
This patient most likely had a cardioembolic stroke based on the MRI. With confirmation of a fib/ PFO/ Left ventricle thrombus, the secondary prevention will be an OAC.
Bonus, when would you start it?
Your patient was just diagnosed with DM what should you start screening for, and how often?
Nephropathy, neuropathy, and retinopathy
on diagnosis and yearly
Bonus: What is the main killer in DM2, and what should you always be considering?
Your patient with known CAD and CKD presents to the clinic with chest pain with activity, and the medications he's on are metoprolol, isosorbide mononitrate, lisinopril, aspirin, and a high-intensity statin. He gets a TTE, cardiac angiogram, and repeat stress test? What would qualify him for IR/ surgical intervention?
High-grade stenosis on the angiogram, HFrEF, significant CAD with viable myocardium (reversible ischemia), refractory to maximal medical therapy.
Bonus: When would you choose CABG over PCI?
A patient rolled into the ED with left-sided paralysis, AMS, and droop. What is the initial workup?
Your patient is 25 years old and presents to the ED with afib with RVR with rates in the 140s. Their BP is 120/80, and they do not complain of any symptoms other than " they can feel their heart going fast" in the acute setting. What is the initial management?
Start with rate control IV beta blocker or Non-DPH CCB
Bonus: Would this patient be a good candidate for rate control in the future? and what is the qualifier
A patient with CKD 4 who has had elevated phosphate levels is reporting back after 3 months of attempting a low phosphate diet, and her lab shows a phosphate of 6. What is the next step? and why is it important?
start a phosphate binder and prevents bone wasting