Paging Dr. Skole; Emergency Emergency
HITs Different
Pretty Little BB
Jet2Holiday
Illnesses Amongst the Stars
100
In what time period should a suspected upper gastrointestinal bleed undergo upper endoscopy?
Within 24 hours
NO DATA suggesting better outcomes with very early scope (<6h) - stabilize first
100
What is used initially to screen for HIT?
4T score
100
What BBs have been shown to improve mortallity in HFrEF
Bisoprolol
Carvedilol
Metop SUCC
100
What is the recommended empiric therapy that you can give to patients who are traveling to use if they develop severe travelers diarrhea?
Azithro 500 x3 days
Rec for severe: fever, dystentary, travel interference or age > 70
Preferred over fluoroquinolone (resistance) or rifaximin, AVOID loperamide if severe
100
This artist, who developed unilateral facial weakness including the forehead that is often associated with HEENT lesions as a result of this syndrome.
Justin Bieber
Ramsay Hunt
200
Compare CTA with a nuclear medicine bleeding scan for bleeding localization regarding
Type of bleeding
Duration
Feature CTA (CT Angiography) Bleeding Scan (Tc-99m RBC)
CTA detects active bleeding ≥ 0.3–0.5 mL/min - good for localization, 10-15 minutes
Bleeding scan detects very slow bleeding ≥ 0.1 mL/min - less precise localization, may require several hours
200
For patients with diagnosed HIT how long should anticoagulation be continued if there is
No thrombosis
Thrombosis
No thrombosis - 1 month
Thrombosis - at least 3 months
200
This medication is first line for the treatment of BB overdose in the setting of bradycardia
Glucagon
Then standard bradycardia protocol
atropine pushes, epi > dopamine, transcutaneous pacing, transvenous pacing
200
The severe version of this travel-related infection is associated with myalgias/arthralgias, rash, hemorrhage, and encephalopathy.
Dengue fever
Myalgias/arthralgias not seen in yellow fever
200
This actress, who has fought a lifelong chronic multisystem inflammatory disorder requiring multiple steroid courses, could safely use this maintenance treatment if she desired pregnancy.
Selena Gomez
Hydroxycloroquine
Most DMARDs contraindicated: mycophenolate, methotrexate, belimumab, cyclophosphamide.
Azathioprine, if absolutely necessary, can be continued, particularly if known nephritis.
300
What medication is often given in a suspected esophageal foreign body that may relieve the obstruction?
Glucagon 1 mg IV
300
Characterize Type 1 HIT (mechanism, time course)
Heparin induced platelet clumping
Mild thrombocytopenia within first 2 days of heparin exposure
Normalization occurs quickly
No treatment changes required
300
What is the preferred BB for primary and secondary proxphylaxis in patients with esophageal varices?
Carvedilol
More pronounced effect than propranolol to reduce the hepatic vein pressure gradient
prevents decompensation, ascites, and bleeding, and improves survival
300
In these groups of patients (4), a tuberculin skin test with induration > 5 mm is considered a positive test.
HIV-positive
Recent contact of person w/ active TB
Presence of fibrotic changes on CXR c/w prior TB
Immunosuppressed - > 15 mg/d of pred, organ transplant
300
This artist, who struggled with a relentlessly debilitating chronic infection characterized by fatigue, neuropathy, and arthritis uncontrolled by initial treatment, likely received what treatment for what duration.
Justin Timberlake
2 g ceftriaxone for 14-28 days for Lyme arthritis unresponsive to initial treatment.
400
What did the WATERFALL trial show?
Describe comparison groups
Why was the trial terminated early?
10ml/kg LR bolus, then 1.5ml/kg/hr (ONLY if hypovolemic) was safer than 20ml/kg bolus followed by 3ml/hr.
60 kg = 600 LR -> 90/hr versus 1200 LR -> 180/hr
Significantly more fluid overload in the aggressive group (20.5% vs. 6.3%).
400
What anticoagulation is preferred for use in patients with a history of HIT undergoing PCI or cardiac surgery
Bivalirudin
400
What can beta blockers cause false positives for on drug screening?
Amphetamines (particularly labetalol and metoprolol, which are structurally similar)
400
Patients with immunocompromising conditions such as ulcerative colitis should receive traveler's diarrhea prophylaxis with this antibiotic.
Travelers' diarrhea prophylaxis with rifaximin is recommended in patients with underlying conditions that place them at higher risk of infection or disease complications (e.g., immune compromise, inflammatory bowel disease, chronic kidney disease).
400
This actor, who has been experiencing worsening personality and behavioral changes, compulsive tendencies, a loss of empathy, and poor insight, might benefit from treatment with which class of medications for behavioral disturbances?
Bruce Willis
SSRIs have shown effectiveness in treating some of frontotemporal dementia symptoms, especially by decreasing the frequency of compulsive behaviors - first line for behavioral disturbances.
500
What mimic of choledocolithiasis is caused by a large gallstone in the cystic duct mechanically impinging on the common bile duct, leading to obstruction?
Mirizzi Syndrome - definitive differentiation is usually by ERCP or MRCP, which can show the stone location and whether it’s intraluminal (choledocholithiasis) vs extrinsic compression (Mirizzi).
500
What catastrophic complication of HIT presents as sudden onset hemodynamic collaspe refractory to fluid resuscitation/pressors?
Bilateral adrenal hemorrhage -> adrenal criss
500
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
RF - old age, cardiac/renal impairment, ACE/ARBs
Vicious cycle of AV block -> worse renal perfusion -> hyperkalemia -> worse AV block
500
Patients with liver disease are at increased risk for infection with this gram-negative bacillus that causes necrotising fasciitis.
Vibrio vulnificus
500
This athlete, who frequently experiences dry eyes, is at increased risk for this malignancy.
Venus Williams
Increased risk for lymphoma, most specifically MALT lymphoma among patients with Sjogren's Syndrome.
Elevated risk for lymphomatous transformation due to chronic activation of tissue lymphocytes.