Angy Heart
NM Disorders
100
According to the ACC 2025 concise clinical guideline, what is the preferred treatment option for patients with pericarditis that fail to respond to NSAIDs + colchicine with inflammatory pericarditis?
Anti-IL-1 - rilonacept, anakira or goflikicept
In addition to continuing NSAID + colchicine
100
Name one FDA approved treatment for ALS
Riluzole - 3 month increased survival (1997)
Edaravone - decreased functional decline (2017)
Tofersen - for rare SOD1 mutation ALS (2023) - increases survival, functional decline (may even stabilize functional decline)
200
What is the most specific and concerning finding on POCUS for cardiac tamponade?
Diastolic right ventricular free wall collapse.
200
Assuming good patient technique, A NIF worse than ___ is concerning for impending respiratory failure
-30
Oftentimes limited by poor technique, so always ask RT if they think seal/effort was good.
300
What finding on cardiac MR is primarily used to establish a diagnosis of pericarditis and grade it's severity?
Late gadolinium enhancement/edema - on phase-sensitivity inversion recovery sequence (ideally fat-suppressed), indicating neovascularization or inflammation
300
A 44F patient reports diplopia, ptosis, and dysphagia that occurs towards the end of the day/before bed. Denies waking up with symptoms. She undergoes evaluation and found to have positive ACh-R antibodies. In addition to electrodiagnostic confirmation, what additional evaluation should they undergo (2)?
Myasthenia Gravis
Chest CT → Thymoma
TFTs → Autoimmune thyroid disease
400
Which patients should be hospitalized for acute pericarditis (5)?
High fevers (>38°C)
Subacute course
Presence of large pericardial effusion with echocardiography features of tamponade physiology
Failure to respond to outpt nonsteroidal anti-inflammatory drugs (NSAIDs)
Concomitant myocarditis
Can consider immunosuppression, oral anticoagulation, and trauma
400
Name 3 meds known to worsen myasthenia
antibiotics including fluroquinolones + macrolides + aminoglycosides
AEDs; antipsychotics, BBs, CCBs, Mg, iodinated contrast rarely
500
How can you establish a definite diagnosis of myocarditis? How about a probable diagnosis?
Definite - Cardiac MRI or endomyocardial biopsy
Possible -
elevated trop
LV +/- RV dysfunction (abnmormal strain, wall motion or reduced EF)
ST-T changes - nonspecific, but still count
500
Which patients with ALS are likely to have a survival benefit of gastrostomy tube placement?
FVC> 50%, ideally before significant weight loss (>10% of BW)
FVC 30-50% less likely to see survival benefit, but may have symptom improvement + weight gain
