Peer Within with a CT
Clinical Trials
Critical ID
Peer with POCUS
FINAL JEOPARDY
200
45-year-old woman presents with sudden shortness of breath, CT chest from the ER is below, what is the most likely underlying diagnosis?
Bonus: Buy 100, reward 300
LAM - lymphangiomyomatosis
Q: What blood test should you order if suspecting LAM, that can obviate the need for a lung biopsy
200
2013 trial showing mortality benefit with proning in patients with severe ARDS
PROSEVA
200
Q: The POET Trial showed that in stable patients with this condition, switching from IV antibiotics to oral antibiotics after 7-10 days of IV therapy was non inferior
A: Left sided endocarditis
200
28-year-old male presents to the Emergency Department complaining of one month of fatigue, shortness of breath, and dyspnea on exertion. Worsened over the past 1 day.
VS: T: 97.7F BP: 129/87. HR: 109 RR: 16. SP02: 95%
POCUS findings as below, what is the most likely diagnosis?
Likely Acute PE
there is dilation of the right side of the heart. In the parasternal short axis you see septal bowing into the left side of the heart, also known as the “D” sign (named after the shape of the left ventricle). These findings are indicative of elevated right sided pressure, or right heart strain, which can be seen in conditions such as acute pulmonary embolism, pulmonary hypertension, COPD, and right ventricular infarction. Given the relatively thin free wall of the right ventricle, the likely cause of right heart strain in the above scenario is an acute process.
400
25 year old male, current 1ppd smoker x 4 years, p/w progressive DOE, HRCT as below. After smoking cessation for one year his CT improved and symptoms resolved completely.
What is the most likely diagnosis?
Pulmonary Langerhans cell histiocytosis (PLCH)
400
2001 study showing early goal-directed therapy (target MAP>65) in patients with severe sepsis or septic shock decreases mortality risk
Rivers trial
400
According to a prospective observational study that evaluated 327 episodes of VAP and 261 episodes of HAP, this pathogen was identified as the culprit organism approximately 60% of the time
A: Pseudomonas Aeruginosa
400
During the COVID-19 pandemic, a 67 year old woman is brought to the ER by family for respiratory distress and altered mental status
Vitals: T: 98.7, HR: 112, BP: 190/110, RR: 40, SpO2 80 on RA
Moderate respiratory distress crackles on exam, no pitting edema. She was placed on a non-breather (avoiding NIPPV) and a thoracic plus cardiac ECHO was preformed.
After reviewing the images, what do think the most likely dx is?
Most likely suffering from heart failure with an acute exacerbation. There are diffuse B-lines, obviously decreased contractility, and a dilated IVC. These images are not typical of COVID-19 infections, which have pleural thickening and scattered b-lines
600
35 year old male, current smoker 10 pack year history, presenting with DOE, had extensive outpatient pulmonary workup, GM-CSF autoantibodies in the blood are positvie and his CT is shown below, what is the diagnosis?
Bonus Question: Buy 100, Reward 300
PAP - Pulmonary Alveolar Proteinousis - idopathic or autoimmune subtype
Q: Secondary PAP can be caused by malignancies and inhalational injuries, can you name one inhalational agent that can cause PAP?
600
2018 study showing no difference in mortality between early or late initiation of RRT in ICU patients with septic shock and AKI
IDEAL-ICU
600
Q: Although there was no significant difference in 90-day all-cause mortality, the ADRENAL Trial did show that treatment with hydrocortisone led to an improvement in 3 secondary outcomes, can you name one of these?
A: shorter duration of initial mechanical ventilation, faster resolution of shock, and fewer blood transfusions received
600
32 year-old woman with history of pleurisy and systemic lupus erythematosus presented to the emergency department with three weeks of shortness of breath and pleuritic chest pain, acutely worse one day prior to arrival.
Vitals: T: 98.3, HR: 130, BP: 142/88, RR: 24, SpO2 97% on RA
A bedside cardiac POCUS and lower extremity scan was preformed. What do you see?
Likely pulmonary embolism. The right lower extremity showed a noncompressible right femoral vein, indicating DVT.
The parasternal short illustrates “D sign” with right ventricular dilation and bowing/flattening of the interventricular septum leading to decreased left ventricular systolic function.
800
45 year old male with history of multiple skin tumors and renal cysts, below is his CT Chest, what syndrome is this?
Birt-Hogg-Dubé syndrome (BHD)
A hereditary condition associated with multiple non-cancerous (benign) skin tumors, lung cysts, and an increased risk of kidney lesions (cysts, benign tumors, and kidney cancer.)
800
2010 trial showing procalcitonin guided antibiotic therapy in ICU patients led to fewer days of antibiotic exposure without significantly increasing mortality
PRORATA
800
DOUBLE JEOPARDY
Q: This acute illness most commonly associated with meningococcemia and occasionally pneumococcal or staphylococcal disease is typically characterized by DIC and sharply demarcated, symmetrical skin lesions that can form bullae leading to skin necrosis
800
35-year-old woman with sickle cell disease presented to the emergency department with localized swelling and pain near her port site. She denied shortness of breath, chest pain, fever, or any other skin changes aside from the swelling.
Vitals: T: 97.8, HR: 64, BP: 144/80, RR: 16, Sat: 96% on RA
A bedside cardiac POCUS was preformed to evaluate the distal tip of the port. What do you see?
Line thrombosis
These ultrasound images show an apical 4 view of the heart. There is a hyperechoic mass in the right atrium that does not shadow, suggestive of a line thrombosis. A CT angio confirmed the diagnosis, showing a large clot adhered to the distal tip of the catheter.
1000
35 year old with history of occulocutaneous albinism and bleeding problems due to platelet dysfunction, now present with slowly progressive dyspnea, the Ct chest is below, what syndrome is this?
Bonus Availbale: Buy 50, reward 500
Hermansky-Pudlak syndrome (HPS) is a rare syndrome which consists of:
- oculocutaneous hypopigmentation (albinism)
- platelet dysfunction
- abnormal storage of autofluorescent pigment (ceroid or lipofuscin)
- typically occurs within lysosomal organelles of the cells of multiple organs and the reticuloendothelial system
Q: there is another syndrome that has all of these feature plus:
- recurrent childhood infection
- peripheral and central neuropathy
- accelerated phase
1000
Seminal 1991 study showing that an RSBI<105 is associated with weaning success
Yang-Tobin Study
1000
Q: Although a less common respiratory infection among travelers, beware of wild rodents that can transmit this viral syndrome that presents with respiratory failure, dizziness, nausea/vomiting, thrombocytopenia, absence of cough, hemorrhagic and renal disease.
A: Hantavirus (Hantaviral Pulmonary Syndrome)
1000
40 year old male presented with 3 days of progressive dyspnea on exertion. He notes he was in a normal state of health prior to this and played basketball daily without issue but now he can no longer walk across the room without becoming winded. He has no chest pain, a normal chest x-ray and an ECG demonstrating sinus tachycardia
Vitals: HR 109 BP 110/72 RR 22 O2 96
Most likely dx?
There is evidence of severe aortic regurgitation and aortic root dilation (~6 cm) on this parasternal long axis view. In a patient without any previous cardiac history with new aortic regurgitation this is concerning for acute aortic dissection
1000
TOPIC: ENDOCRINOLOGY
Most likely mechanism of disabling hypoglycemia after gastric bypass surgery