CHB
CCB
Lungs
CAP
The News
100
What lab test can rule OUT an acute aortic dissection?
D-Dimer; <500
Reflects activation of extrinsic pathway of coagulation cascade by TF exposed in aortic media
100
What is electrical capture and mechanical capture when trancutaneously or transvenously pacing? Name 2 situations in which you might have a discrepency between the two.
Electrical capture refers to the pacemaker stimulus successfully depolarizing the myocardium, evidenced by a pacing spike followed by a wide QRS complex on the ECG.
Mechanical capture refers to the heart actually contracting in response to that electrical depolarization, producing a palpable pulse and hemodynamic output
PEA, severe metabolic derangements, MI, tamponade, prolonged cadiac arrest, AV nodal blockage
100
What can respiratory therapists measure serially in patients with advanced ALS to help predict impending respiratory failure?
NIF - negative inspiratory force once >-30 sign of impending resp failure (first major measurement to change)
FVC - forced vital capacity - also measured by RT, tends to decrease after NIF has started dropping, but well validated for impending resp failure
100
According to the IDSA, when is it appropriate to cover for anaerobes in pneumonia?
Abscess/empyema or necrotising pneumonia.
Newer data shows low prevalence of anaerobic lung infections even in suspected aspiration, possibly due to demographic shifts/better dentition.
100
This actress recently got engaged to Harry Styles, after previously breaking off engagements with Channing Tatum and divorcing Karl Glusman.
Zoe Kravitz
200
This medication is first line for the treatment of BB overdose in the setting of bradycardia
Glucagon
Glucagon bypasses β-receptors blocked by BB to directly activate adenylate cyclase ↑ cAMP → Improves heart rate and contractility
Unlikely to respond to atropine
If responsive can treat with glucagon infusion +
If fail glucagon -> ACLS protocol
atropine pushes, epi > dopamine *high dose insulin*, transcutaneous pacing, transvenous pacing
200
Name two first-line treatments targeted at the pathophysiology of calcium channel blocker toxicity with hemodynamic compromise (AKA not act charcoal, bowel cleanse)
AHA 2025 guidelines
Calcium - often pushes of 2 g calcium gluconate, 10 g daily per fellow
High dose insulin GGT w/ dextrose - 1 unit/kg bolus -> 0.5 units/kg/hr - improves cardiac contractility
High dose vasopressors (often much higher than normal) - CCB toxicity is thought to be protective against digital ischemia
200
In a patient presenting with moderate or advanced idiopathic pulmonary fibrosis, what might you expect their % predicted values be for:
FEV1
FVC
TLC
DLCO
FEV1: Normal, slightly decreased
FVC: Decreased
TLC: Decreased
DLCO: Decreased, usually first seen and most severe abnormality
200
What is the shortest duration of antibiotics recommended by IDSA/ATS for the treatment of pneumonia, and what requirements must be met to be a candidate for shortened treatment course?
3 days
"clinical stability" - literally just normal vitals
200
Which rapper ended their relationship with their significant other this week, accusing their SO of cheating?
Megan Thee Stallion
"Trust, fidelity, and respect are non-negotiable"
300
Name a class 1 indication for cardiac resynchronization therapy.
Classic - Symptomatic HFrEF w/ EF < 35% NSR + LBBB + QRS > 150ms on max tolerated GDMT
QRS 120–149 ms (especially non-LBBB) → weaker evidence (Class IIa/IIb), or no LBBB but QRS>150
Other class 1 indications - Symptomatic HFrEF w/ EF < 35% + need for pacing (ex high grade AVN block) or Symptomatic HFrEF w/ EF < 35% + a fib
300
What non-hemodynamic-related marker did the toxicology fellow say is useful for prognosticating patients with CCB overdose/toxicity?
Glucose - percentage increase in peak serum glucose is better predictor of severity of illness than hemodynamic derangements in verapamil and diltiazem overdoses.
Block L-type calcium channels on pancreatic beta cells, impairing insulin secretion and inducing insulin resistance at the cellular level.
300
Define N0, N1, N2 and N3 for lung cancer
N0 no nodes
N1 distal nodes (eribronchial, hilar, and/or intrapulmonary)
N2 ipsilateral mediastinal/subcarinal nodes
N3 contralateral medistinal or extending up to either side scalene/supraclavicular (Virchow Node)
300
When should you consider adding corticosteroids to a patient diagnosed with CAP per new ATS guidelines?
When considered "severe"
Major Criteria (either one qualifies):
Septic shock with need for vasopressors
Respiratory failure requiring mechanical ventilation
Minor Criteria (≥3 required if no major criterion):
Respiratory rate ≥ 30 breaths/min
PaO₂/FiO₂ ratio ≤ 250
Multilobar infiltrates
Confusion/disorientation
Uremia (BUN ≥ 20 mg/dL)
Leukopenia (WBC 4,000 cells/μL) — due to infection alone, not chemotherapy
Thrombocytopenia (platelets 100,000/μL)
Hypothermia (core temperature 36°C)
Hypotension requiring aggressive fluid resuscitation
300
A single released by this artist on April 17th had a meteoric rise to become the Billboard #1 on its first week; a preview of their highly anticipated album set to release June 12th.
Olivia Rodrigo - Drop Dead
400
70 y/o M w/ CKDII and HTN started on coreg 1 week ago presents w/ dizziness. HR is 47, BP is 101/67 mmHg, Cr is 2.5 and K is 6.2.
What is the diagnosis?
BRASH - bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia
In setting of appropriately dosed BB/CCB
RF - old age, cardiac/renal impairment, ACE/ARBs
Vicious cycle of AV block -> worse renal perfusion -> hyperkalemia -> worse AV block
Usually, BB can be resumed afterward, though that terrifies me
400
29-year-old male presents with intermittent palpitations. His baseline EKG is below.
While you are evaluating him, his heart rate accelerates and sustains in the >200. He is feeling palpitations, but denies dizziness, lightheadedness, chest pain, or any other associated symptoms. BP is 100/60.
Name a first line medication for treating this patients tachycardia.
A fib w/ pre-excitation (WPW)
IV procainamide or ibutilide (Class 1). Cardiovert if unstable
Avoid AVN blockers (CCB, BB, amio, dig) - can lead to preferential conduction via the accessory pathway and uninhibited ventricular conduction -> possible degeneration into VT or VF.
400
How is diffuse alveolar hemorrhage definitively diagnosed?
Serial bronchoalveolar lavage - squirt saline into lung parenchyma sequentially and draw up fluid x3 ->you should see increasingly bloody sputum.
400
What is the preferred first-line empiric treatment for suspected non-severe pseudomonas pneumonia at PMPMC? How about severe pseudomonas pneumonia
Cefepime (96% suceptible)
NOT pip-tazo - no need for anaerobic coverage, more resistance (86% suceptible)
For severe, cefepime + tobramycin
400
This rapper and Trump sycophant got backlash from her fan base after posting an AI-generated picture of Melania Trump to celebrate her birthday.
Nikki Minaj
500
Which types of heart block are unlikely to respond to atropine?
MOA - By blocking the parasympathetic (vagal) influence on the sinoatrial (SA) and atrioventricular (AV) nodes, it increases the firing rate of the SA node, and accelerates conduction through the AV node .
Inneffective for blocks below the AV node, and may in fact worsen blocks in the His bundle or ventricles - Mobitz II and CHB with infra-nodal escape rhythm (wide QRS).
500
What is north-south (Harlequin) syndrome in VA ECMO and why does it occur?
- Try to Improve the oxygen perfusion with high-frequency ventilation (This is logical first step , to improve the native lung function)
- ECMO flow rate may be increased and overdrive the LV ejection .(This can be counter-productive as we are hitting a recovering ventricle)
- Converting to VV or VAV ECMO if the hemodynamics allows. This is possible as North-south syndrome is a sign of recovering cardia function VV ECMO will convert it into a primary lung support
500
Name 2 lab findings that can be used to diagnose an empyema
pH <7.2, Gluc < 40 , positive gram stain/culture and LDH>1000
Any onemakes an empyema, also if it is frankly purulent on initial tap
Empyema's should always be evaluated for chest tube placement by IP. Also will need follow up CT to ensure resolution.
500
Which of the following population/s diagnosed with a seasonal respiratory virus and pneumonia did the 2025 ATS CAP guidelines endorse empirically treating with antibiotics, while the IDSA disagreed with empirical treatment?
1 Outpatients without comorbidities
2 Outpatients with comorbidities (ex TIIDM)
3 Inpatients with nonsevere CAP
4 Inpatients with severe CAP
Outpatients without comorbidities → Do NOT prescribe empiric antibiotics (IDSA agreed)
Outpatients with comorbidities (HF, lung disease, CLD, TIIDM, many others) → Prescribe empiric antibiotics (IDSA disagreed)
Inpatients with nonsevere CAP → Prescribe empiric antibiotics (IDSA disagreed)
Inpatients with severe CAP → Prescribe empiric antibiotics (IDSA agreed)
500
Tough week for this bravo star - his cousin was just accused of shooting and murdering their grandmother
West Wilson - Summer House
His cousin Dakota Sweeney arrested and charged after allegedly shooting their grandmother following an argument at her home.