Purple-Delirium
Green-Drug Allergy
Blue-Houser's Hodge Podge
1
These are the three domains of clinical features of delirium
attention deficits, memory impairment, and orientation impairment
1
This is the percent of pencillin allergies that overlap with a cephalosporin allergy.
2%
1
This artist made history with his album being the first-ever non-English album to win Album of the Year award at the Grammys.
2
These are 3 of the 5 non-pharmacological treatments strategies for delirium that you can complete inpatient.
2
A patient with selected IgA deficiency needs RBCs. What type of blood product do you need to order?
Washed RBCs. This removes plasma proteins, including IgA.
IgA deficiency is the 2nd most common immunodeficiency in adults.
2
This is the country in which filming for the popular U.S. Show "Traitors" occurs.
What is Scotland?
3
These are 3 reasons that IV administration of haloperidol is superior to PO or IM administration for emergency treatment of delirium.
3
A densensitization process is completed for a needed medication. After the medication is stopped, how long does the desensitization effect last?
A short 24-48 hours.
3
LCDR Tallant served as the SMO of this ship.
USS Mesa Verde
4
_____mg of IV Haldol is equivalent to ____mg of PO Haldol.
1 & 5?
4
An NSAID is indicated, but a patient has had a reaction of wheezing and congestion with aspirin and ibuprofen in the past. Which NSAID is likely to be the safest to try in this patient?
Celecoxib.
ASA and ibuprofen are both have predominately COX1 inhibition, vs COX2 in celebrex.
4
This ship recently spent 286 days at sea, 208 of which were without a port call, before arriving in Thailand.
What is the USS Abraham Lincoln/CVN-72?
5
These are the 4 major categories to consider as differentials for symptoms of delirium.
1. Intracranial disease, 2. systemic disease affecting brain, 3. intoxicaton/ingestion, and 4. substance withdrawal
Remember the white board drawing!
5
DRESS, when severe (signs of organ injury), should be managed with what 2 medication changes?
1. Stop offending agent
2. Start systemic glucocorticoids
5
In the book Project Hail Mary, this is the star system that the Hail Mary travels to because it is the only one not infeted by the organism.
Tau Ceti
6
This is the dose ratio of lorazepam to haldol that was recommended if you need to use lorazepam in a patient with delirium.
1 lorazepam:2 Haldol
But remember, we want to avoid benzos as they can worsen delirium.
6
Which cephalosporin has MSSA coverage and has a different R1 group, making it a better option for a patient with penicillin allergy?
Cefazolin
6
This is the oldest continuously operating military hospital in the United States.
What is Naval Medical Center Portsmouth?
7
These are the 2 atypical antipsychotics most recommended in delirium if a medication is needed and you cannot use haldol.
olanzapine and quetiapine. Risperidone is also a recognized option, but has more side effects.
7
What are 2 clinic signs present in SJS/TENS that could differentiate this reaction from a generalized fixed drug reaction?
1. fever
2. mucosal involvement
3. timeline (fixed drug reaction is 1-2 weeks vs 1-4 weeks for SJS/TENS)
7
On this day in 1957, troops from this U.S. Army division escorted 9 African American students into Central High School in Arkansas to enforce federal desegregation orders
What is the U.S. Army's 101st Airborne Division?
8
This is the characteristic finding you would expect to see on EEG for delirium
generalized slowing
Alpha waves -->theta/delta
8
What is the allele most commonly associated with allopurinol hypersensitivity reactions?
HLA-B*58:01
Check this in certain populations (do you know which ones?) before starting allopurinol for gout!
8
This is the name of Taylor Swift's new single that comes out TODAY
What is 'Patient Zero'?
9
Which medication has some evidence for effectiveness in regulating sleep-wake cycles, theoretically helping to avoid delirium?
melatonin/ramelteon
(MKSAP19 and discussed in lecture)
9
What is the time from first dose to onset of DRESS?
2-8 weeks
9
By what mechanism does BIPAP improve ventilation?
What is "driving pressure"?
Driving pressure = IPAP - EPAP
10
What scoring tool frequently used in the ICU setting is useful in distinguishing delirium from other forms of cognitive impairment?
CAM (Confusion Assessment Method).
This is endorsed by MKSAP as well. There are shorter and longer version of CAM that can be applied to different settings.
MOCA and MMSE were also mentioned as ways to determine the type of cognitive impairments for diagnosis (attention, memory, etc)
10
What Gell and Coombs Type does a fixed drug eruption fall under?
Type IVa
10
This is why auto-PEEP happens in COPD patients who are intubated.
Big floppy, over-compliant COPD lungs = prolonged exhalation time
If respiratory rate too fast, patient doesn't have time to exhale all the tidal volume.
Volume builds up = pressure builds up.
Pressure at alveoli level (PEEP) is no longer what you set, but what you set PLUS built-up pressure. This is auto-PEEP.
You have to lower the respiratory rate to give the patients more time to exhale.