UWISH
Game of Crohn’s
ITP or Not ITP
Bupe There It Is
The Garden State
100
In a patient with ASC-US on Pap smear, this test is used to determine the need for further evaluation with colposcopy.
What is high-risk HPV testing?
100
This fecal marker is useful for distinguishing inflammatory bowel disease from functional disorders such as IBS.
What is fecal calprotectin?
Roughly 85–90% sensitive and ~90% specific for distinguishing IBD from IBS, depending heavily on cutoff.
100
These two viral infections are routinely screened for because either can cause secondary ITP.
What are HIV and hepatitis C?
100
This effect refers to Buprenorphine's impact on breathing flattening out at higher doses, which lowers the risk of fatal overdose compared to full opioids.
What is the Ceiling Effect?
100
This Newark-born basketball star was the No. 1 overall NBA draft pick in 1992 and gave himself the nickname “The Big Aristotle.”
Who is Shaquille O’Neal?
200
(THRICE) DAILY DOUBLE
These two classes of medications can be used as initial treatments for eosinophillic esophagitis.
What are PPIs and swallowed steroids?
EoE → PPI +/ swallowed topical steroid → if inadequate response/severe disease → dupilumab (IL4/13 blocker, dupixant)
200
Before initiating an anti-TNF agent, patients should be screened for these two important latent infections.
What are TB and Hep B?
TNF blockade can cause TB reactivation and increases concern for HBV reactivation.
200
This platelet count is the usual treatment threshold for an otherwise asymptomatic adult with newly diagnosed ITP.
Adults with platelets ≥30,000/µL and only minor or no bleeding are often observed; below this, corticosteroid treatment is generally favored.
200
These are the mechanism of actions of naltrexone, buprenorphine and methadone.
What is:
?
200
This New Jersey-born basketball legend led the Lakers to five NBA championships and scored 81 points in a single game.
Who is KOBE?
300
For suspected HIT, this high-sensitivity, low-specificity test is used for screening, while this high-specificity functional assay is used for confirmation.
What are the PF4-heparin ELISA and serotonin release assay (SRA)?
USE the 4T score to risk stratify BEFORE sending any test.
300
Ulcerative colitis is associated with this autoantibody, which is relatively specific but poorly sensitive for the disease.
What is p-ANCA?
It is found in roughly 50–70% of UC patients but is not sensitive enough for diagnosis.
300
(THRICE) DAILY DOUBLE
This bacteria should routinely be considered in adults with newly diagnosed ITP because treating it can improve thrombocytopenia in some patients.
What is H. pylori?
H. pylori testing is recommended in appropriate populations/settings, and eradication can produce a platelet response in some infected patients.
300
For standard buprenorphine induction, providers should generally wait to start treatment until COWS scores are above this number.
What is COWS > 8-12
Explanation: Waiting for clear moderate withdrawal reduces the risk of buprenorphine-induced precipitated withdrawal, particularly after fentanyl exposure.
300
Born in Englewood, this actor played Tony Soprano, perhaps New Jersey’s most famous fictional resident.
HINT: he has a rest stop named after him in Bergen County
Who is James Gandolfini?
400
These three exam finding represent the classic triad for a fat embolism.
What is petechial rash, altered mentation and respiratory distress?
400
(THRICE) DAILY DOUBLE
This dermal manifestation of IBD will parallel IBD diease activtiy.
What is erythema nodosum?
400
These oral agents treat persistent ITP by stimulating the plt production rather than suppressing platelet destruction.
What are TPO receptor agonists?
Eltrombopag and avatrombopag stimulate platelet production; romiplostim is an injectable TPO-RA.
400
_____ reperesents the half-life of Buprenorphine and _____ represents the half life of methadone.
Give me one number. anything within the range will count
Bupe: 24–42 hours
Methadone: 15 to 55 hours
Buprenorphine has a long elimination half-life (~24–42 hours for transmucosal formulations), but its analgesic effect is much shorter, roughly ~6–8 hours.
TEACHING POINT: Bupe is often dosed BID or TID and given for palliative pain control!!
400
Born in Newark, this singer became the first woman to debut at No. 1 on the Billboard 200 and remains one of the best-selling recording artists ever.
Who is Whitney Houston?
500
This diagnostic test is the more sensitive than abdominal XRs at diagnosing a bowel perforation and should be obtained if clinical suspicion remains high despite negative XRs.
Be specific.
CT AP w/ water soluble contrast
X-ray for GI perforation/free intraperitoneal air:
- Sensitivity: ~50–70% overall (higher with upright chest X-ray and larger amounts of free air)
- Specificity: ~90–95%+
- CT abdomen/pelvis: much more sensitive, generally >90% for detecting perforation/free air.
Board pearl: A negative X-ray does NOT rule out perforation → if clinical suspicion remains high, get CT abdomen/pelvis.
500
This is the first line treatment for a young patient with crohns presenting with recurrent urinary tract infections, pneumaturia, and fecaluria with imaging demonstrating an uncomplicated vesicocolonic fistula.
What is a TNF-a inhibitor.
The reasoning is:
- Anti-TNF therapy (especially infliximab) treats the underlying Crohn’s inflammation and can promote fistula closure.
- Surgery is more strongly considered when medical therapy fails, the fistula causes persistent/recurrent severe infections, there is an abscess or obstruction, or there is significant structural bowel disease requiring resection.
500
These two protein complexes are the principal platelet-surface targets of the autoantibodies detected in only about 50–60% of ITP patients.
Name one.
What are GPIIb/IIIa and GPIb/IX.
TP autoantibodies most commonly target GPIIb/IIIa and GPIb/IX, promoting platelet clearance and potentially impairing platelet production/function. Platelet autoantibody testing has limited sensitivity, so a negative test does notexclude ITP.
Glanzmann's Thrombasthenia affects this!
500
Methadone, along with other opioids, can rarely be associated with this electrolyte abnormality.
(Explain why!)
What is hyponatremia 2/2 SIADH.
Opioids can stimulate ADH release and/or enhance its antidiuretic effects
500
Before becoming a three-time Academy Award winner, this New Jersey native attended Bernards High School and later portrayed Margaret Thatcher on screen.
Who is Meryl Streep?