Pediatrics
Your 1st patient at your 1st freestanding shift is a 4 week old Nepali baby that projectile vomits white emesis onto you. The family reports he seems hungry but vomits profusely after every feed. What is the diagnosis?
Pyloric Stenosis
You order Octreotide and Ceftriaxone from the massive hemetemesis order set for your patient in Rm 5 with a cirrhosis and upper GI bleed. Why are these medications given?
Octreotide causes splanchnic vasoconstriction, which decreases bleeding. Ceftriaxone decreases mortality by preventing SBP
CIA-4 has fever, + Murphy sign, and scleral icterus . Your RUQ pocus shows CBD of 9 mm. What is your diagnosis?
Ascending cholangitis
Your abdominal pain patient is an old grandma with newly identified afib. When you gently palpate her abdomen, she screams loud enough for the waiting room to hear. What should be at the top of your differential?
Acute mesenteric ischemia
A 52 yo is diagnosed with intussusception. How is the treatment of this pathology different from pediatric treatment of the same condition?
Adults need surgery, not an enema
Dr. Singer won’t let you zo-po-go your vomiting, fussy 2 weeker because the patient was born premature. What diagnosis should be ruled out before discharge?
Necrotizing Enterocolitis
Negin is halfway through her doxycycline course for Lyme disease when she begins to experience intense substernal chest pain, worse with eating and drinking. She has been taking the pills without water before she goes to bed. What is the most important intervention to ensure she is treated appropriately?
Take pill with water, stay upright, change pill to liquid form, or change antibiotic
You receive your test results after an accidental needle stick. You find out you are HBsAg +. How do you interpret this result?
Acute Hep B infection, the first marker for infection
A 60 yo M presents with a new mass at his umbilicus. There is ecchymosis to the mass that started 45 mins prior to arrival. Triage lactate is elevated. What is diagnosis and treatment?
Strangulated hernia, do NOT reduce, call surgery
Chris asks you to ultrasound him after having pain in his RLQ for the past week. What diameter of appendix on ultrasound indicates appendicitis?
> 6 mm
Dr. Gupta already dispo’d your patient in Rm 30 after reading the triage note which reads “18 mo with intermittent belly pain, emesis, and red stools.” What imaging do you order?
Ultrasound for intussusception
Your patient hands you her + H. Pylori test results from an outside hospital and requests treatment. She is unable to contact her previous doctor. What medications are included in standard triple therapy?
PPI, clarithromycin and amox/ metronidazole.
A patient with known cirrhosis presents requesting a paracentesis. You identify a significant AKI on his lab work. What intervention improves mortality in patients with hepatorenal syndrome?
Albumin
Your front room patient has multiple large, bloody bowel movements after having AAA repair 5 days ago. Where is the most common site for aortoenteric fistula formation?
duodenum
A boarded patient has new onset left sided abdominal pain and a large bloody bowel movement. He was admitted for severe dehydration and only received 500 cc of fluids in the past 48 hours. What diagnosis should be at the top of your differential?
Ischemic colitis
Dr. Ramundo tells you go to Rm31 pronto for a 1 monther who is puking green. You notice the patient’s belly is distended and the patient needs vigorous stimulation for response. What imaging is the gold standard for this pathology?
Upper GI series for Malrotation
A patient presents after ingesting drain cleaner in a suicide attempt 20 minutes ago. Your medical student suggests activated charcoal. What is the indicated treatment for stable and unstable patients with this pathology?
Stable: urgent endoscopy; Unstable: emergent surgical consultation
You have a cirrhotic, IVDU patient who presents with a family member. The family member asks you how likely it is that the patient will develop chronic liver disease from their current liver infection. Which hepatitis type is most likely to cause chronic disease?
Hepatitis C
A 33 yo patient complains of joint pain, mouth ulcers, abdominal pain, and persistent diarrhea. What findings would you expect to see on their most recent colonoscopy?
Skip lesions, cobblestone mucosa, transmural inflammation in Chron's Disease
A 40 yo F presents with 2 days of horrible diarrhea after a trip to Bangladesh. Her sodium is found to be 112. What bacteria do you suspect to be causing her diarrhea?
Shigella
Your KUB on a vomiting 1 month old shows a double bubble sign with distal gas present. The patient has had bilious vomiting and is now hypotensive with a distended belly. What is the definitive emergent treatment for this condition?
Surgery (Ladd procedure) For Malrotation
You are observing a coresident drinking liquid from a small glass attached to a ski. Your coresident accidentally swallows the lemon peel that was attached to the glass. He reports he feels it is “stuck” in his chest. What is the most common cause of impacted esophageal food boluses?
Schatzki rings, associated with reflux
A 23 yo M with ulcerative colitis presents with Reynold's pentad. What underlying condition do you suspect led to his presentation?
Primary sclerosing cholangitis
A 57 yo F presents with flushed skin, wheezing, and diarrhea. She reports she recently had outpatient testing that revealed an increased urinary 5-hydroxyindoleacetic acid level. What is the diagnosis?
Carcinoid syndrome
A 19 yo M with pmh significant for sickle cell dz presents with diarrhea and leg pain. It started after eating a soft boiled egg from his farm’s chickens. He has fever, abdominal cramps, and left thigh pain. You suspect salmonellosis. What complication do you need to warn the patient of?
Osteomyelitis