Don't break my heart
Pick your poison
Creepy Crawlies
Witch's Stew
Halloween Trivia
200

Suspect the following in a patient endocarditis, heart failure and new onset heart block 

Paravalvular absess

200

A feared complication of ingestion of this toxic alcohol is blindness due to retinal toxicity. Labs will show an elevated osmolar gap and a high anion gap metabolic acidosis 

Methanol 

*Treat with fomepizole

200

Suspect bites from this household nuisance in a patient with these painless but pruritic skin lesions that appeared after staying in a dirty budget motel


Beg Bugs (accept Cimex lectularius)

Treatment: eradication of furniture, wash sheets on high heat, hire exterminator

200

Complex pulmonary hypersensitivity reaction seen almost exclusively in patients with asthma or cystic fibrosis that can lead to chronic bronchiectasis and eventual fibrosis if untreated

Allergic bronchopulmonary aspergillosis 

*Treatment: corticosteroids + itraconazole 

200

Is a pumpkin a fruit or vegetable? 

Fruit 

400

Most common underlying risk factor for endocarditis 

Structural Heart Disease 

*75% of cases! 

**Includes rheumatic heart disease, degenerative valvular lesions, aortic valve disease, congenital heart disease 

400

Suspect ingestion of this toxic alcohol in a patient presenting with confusion, a high osmolar gap, a negative anion gap and no acidosis 

Isopropyl alcohol 

*Only toxic alcohol with no anion gap or acidosis 

400

Arthropod borne viral infection associated with fevers, frontal headache, retro-orbital pain, myalgias and severe lumbosacral pain. Severe cases can progress to hemorrhagic shock with multi organ failure. Treatment is supportive

Dengue fever 

*Termed "break bone fever" 

400

Consider this "must not miss" diagnosis in a patient receiving chemotherapy who presents with neutropenic fever and abdominal pain. 

Neutropenic Enterocolitis (accept Typhlitis) 

*Diagnosis: Contrast abdominal CT

**Empiric tx: Zosyn or Cefepime and flagyl

***Can progress to bowel perforation and death 

400

Term for a male witch 

A warlock 

600

Name this rhythm


Multifocal atrial tachycardia 

*Rapid irregular rhythm > 100 bpm with at least 3 distinctive P-wave morphologies

600

Suspect toxicity of this substance in a patient with confusion, blurring and yellowing of vision, vomiting and this EKG: 


Digoxin toxicity (accept dig toxicity, cardiac glycoside toxicity)

*Treat with Dig specific ab, HD if not effective

600

Infection with this gram negative pleomorphic bacteria can occur worldwide, with clinical presentation including fever, headache, malaise, arthralgia conjunctivitis, and pharyngitis often accompanied by a maculopapular, vesicular, or petechial rash. It is transmitted via fleas, mites, lice and ticks. Pathogenesis is related to microvascular permeability causing vasculitic appearing skin lesions. Tick borne illness from this pathogen in the US causes Rocky Mountain spotted fever


Rickettsial infections

*Treatment: Doxycycline for 7-10 days

600

Suspect this culprit class of medications in a patient with chronic osteoarthritis related pain and treatment resistant hypertension 

NSAIDs

600
This country celebrates the Day of the Dead 

Mexico

800

Name this rhythm 


Wandering Atrial Pacemaker 

*Same as MAT with rate <100

800

Suspect this diagnosis in a patient that becomes cyanotic after receiving local lidocaine during a minimally invasive procedure 

Methemoglobinemia

*Occurs from exposure to oxidizing substances (dapsone, nitrites, local/topical anesthetics). Patient becomes cyanotic pulse ox ~85% and dark chocolate covered blood. Normal PaO2 on ABG. Treat with methylene blue!

800

This illness transmitted via the lone star tick causes fever, myalgias and headaches. It can cause a nonspecific rash in 30% of adults.  Basophilic inclusion bodies can be seen in monocytes on peripheral smear as shown below: 


Erlichiosis

*Anaplasmosis is very similar, however inclusions are seen in GRANULOCYTES and rash is rare. 

**Tx both with doxy 

800

Rare cystic lung disease seen in women in their 30s – 40s and associated with spontaneous pneumothorax and chylous effusions. 


Lymphangiomyomatosis (LAM)

800

This famous magician died on Halloween in 1926

Harry Houdini (accept Houdini)

1000

Rare disease characterized by biventricular enlargement, refractory ventricular arrhythmias, and rapid progression to cardiogenic shock in young to middle-aged adults. Histologic examination demonstrates the presence of multinucleated giant cells in the myocardium.

Giant Cell Myocarditis 

*Treatment immunosuppressants and/or LVAD placement or cardiac transplantation

1000

Suspect this culprit medication in a patient with hyperosmolar hypernatremia whose urine osmolality does not increase with desmopressin (DDAVP) 

Lithium!

*Treat with lithium discontinuation. Amiloride or thiazide diuretics if cannot d/c lithium 

1000

Suspect this infection in a homeless elderly patient with untreated HIV who often sleeps in very crowded shelters and has these hand findings: 


Crusted scabies (accept scabies)

*Crusted variant is highly contagious and causes thick, concrete scales, it is seen in immunocompromised patients. 

1000

This rare genetic syndrome presents with ventricular ectopy and monomorphic VT heart failure. Cardiac MRI shows enlargement, focal aneurysms and hypokinesis of the right ventricle.

Arrhythmogenic right ventricular dysplasia 

*Patients should abstain from vigorous exercise.

**Tx: beta blockers, ICD to prevent SCD, antiarrythmics, catheter ablation 

1000

The first jack o'lantern was carved from which vegetable? 

A Turnip