BOARD BASICS (ALLITERATION!)
BIOSPY SPECIMENS WILL SHOW >15 PINK-STAINING WHITE BLOOD CELLS PER HPF, CONFIRMING THIS DIAGNOSIS FOR THOSE WHO SUFFER FROM GERD, FOOD BOLUS IMPACTION, AND ATOPIC CONDITIONS.
WHAT IS EOSINOPHILIC ESOPHAGITIS?
(EGD IN PATIENTS WITH EOE MAY SHOW EDEMA, RINGS, LONGITUDINAL FURROWS, LUMINAL NARROWING, EXUDATE, AND SOMETIMES STRICTURES. BIOPSY SHOWED MARKED INFILTRATION WITH EOSINOPHILS, >15/HPF.)
AN EARLY DIASTOLIC "PLOP" CAN BE AUSCULTATED IN THIS CONDITION.
WHAT IS ATRIAL MYXOMA?
(ALSO OCCASIONALLY HEART IN BACTERIAL ENDOCARDITIS, TYPICALLY OF THE MITRAL VALVE.)
A LOW SPOT URINE POTASIUM/CREATININE RATIO (<13-15 mEq/g) TYPICALLY INDICATES THIS ETIOLOGY FOR HYPOKALEMIA.
(CAN NAME BROAD CATEGORY OR SPECIFIC)
WHAT IS EXTRA-RENAL?
(LACK OF INTAKE, TRANSCELLULAR SHIFTS, GI LOSSES)
A 70 YO FEMALE WITH A HISTORY OF C. DIFF COITIS PRESENTS WITH SEPSIS SECONDARY TO PAN-SENSITIVE E. COLI UTI. IN ADDITION TO CEFTRIAXONE, SHE NEEDS TO BE ON THIS ANTIBIOIC.
(DRUG, DOSE AND DURATION, PLEASE!)
WHAT IS ORAL VANCOMYCIN 125 MG DAILY FOR 7 DAYS AFTER COMPLETION OF OTHER ANTIBIOTIC(S)?
USE CAUTION WHEN ADMINISTERING THIS VASOPRESSOR IN ASTHMATIC PATIENTS WITH SULFITE ALLERGIES.
REGARDLESS, DR. GOYAL REMINDS YOU IT'S THE G.O.A.T.!
WHAT IS LEVOPHED?
(BRAND NAME LEVOPHED CONTAINS SODIUM METABISULFITE. IN THOSE WITH SULFITE ALLERGY/SENSITIVITY, ASTHMATIC SYMPTOMS CAN OCCUR WITH EXPOSURE, BUT THIS IS UNCOMMON WITHOUT AN UNDERLYING HISTORY OF ASTHMA.)
RISE AND SHINE! A MORNING CORTISOL LEVEL OF <3 uG/dL CONFIRMS IT, WHILE A LEVEL OF >15 uG/dL EXCLUDES IT.
(MOST COMMON CAUSE IS AN ALLITERATION!)
ADRENAL INSUFFICIENCY (AUTOIMMUNE ADRENALITIS)
(A MORNING ACTH LEVEL CAN HELP DISTINGUISH BETWEEN PRIMARY AND SECONDARY AI IN PATIENTS WITH UNEQUIVOCALLY LOW CORTISOL LEVELS.)
A 55 YO MALE WITH UNCONTROLLED HYPERTENSION PRESENTS WITH SUDDEN ONSET SEVERE DYSPNEA AND CHEST PAIN. STEMI NOTED ON EKG. STAT ECHO PRIOR TO THE CATH LAB SHOWS TTE SHOWS SEVERE MITRAL REGURTITAION. PCI WAS MOST LIKLEY PERFORMED TO THIS VESSEL.
WHAT IS THE RIGHT CORONARY ARTERY (RCA)?
(INFERIOR WALL MI COMPLICATED BY PAPILLARY MUSCLE RUPTURE/ACUTE MITRAL REGURGITATION. THE PAPILLARY MUSCLE IS SUPPLIED BY THE POSTERIOR DESCENDING ARTERY, WHICH ARIESES FROM THE RCA IN 70-85% OF PEOPLE.)
HYPOKALEMIC PERIODIC PARALYSIS IS A RARE NEUROLOGIC MANIFESTATION OF THIS ENDOCRINE DISEASE.
WHAT IS HYPERTHYROIDISM/THYROTOXICOSIS?
(ATTACKS ARE PRECIPITATED BY STRENUOUS EXERCISE OR HIGH CARBOHYDRATE LOAD. MORE COMMON IN EAST ASIAN POPULATIONS, MORE COMMON IN MEN THAN WOMEN.)
THE MERINO TRIAL PROVED THAT THIS ANTIBIOTIC SHOULD NOT BE USED TO TREAT ESBL ORGANISMS.
WHAT IS ZOSYN (PIPERACILLIN-TAZOBACTAM)?
(SENSITIVITY CAN BE A RED HERRING! EVEN IF AN ESBL ORGANISM SHOWS SENSITIVITY TO ZOSYN, DON'T SELECT IT!!! USE A CARBAPENEM INSTEAD.)
DR. VAN BOENING FELT YOU SHOULD KNOW THAT THIS RARE CONDITION IS A COMPLICATION OF LONG-STANDING SEROPOSITIVE RHEUMATOID ARTHRITIS CHARACTERIZED BY A TRIAD OF ARTHRITIS, SPLENOMEGALY, AND NEUTROPENIA.
WHAT IS FELTY SYNDROME?
(PATIENTS ARE AT RISK FOR SEVERE BACTERIAL INFECTIOUS, LOWER EXTREMITY ULCERATIONS, LYMPHOMA, AND VASCULITIS.)
IN THE SMOLDERING FORM OF THIS DISEASE, BONE MARROW BIOPSY SHOWES 10-59% CLONAL PLASMA CELLS IN THE ABSENCE OF CHARACTERISTIC SYMTPOMS/CRITERIA.
WHAT IS MULTIPLE MYELOMA?
(SMOLDERING MM HAS A 10% RISK PER YEAR FOR CONVERSION TO MM WITHIN THE FIRST 5 YEARS FOLLOWING DIAGNOSIS.)
WARFARIN REMAINS THE FIRST LINE THERAPY FOR PREGNANT PATIENTS WITH MECHANICAL HEART VALVES, AS LONG AS THE DOSE REMAINS BELOW ___ mg/DAY.
WHAT IS 5 mg/DAY?
(WHEN WARFARIN DOSE EXCEEDS 5 MG/DAY, USE LMWH IN THE FIRST TRIMESTER, THEN RESUME WARFARIN. ANTICOAGULATION THERAPY IN PREGNANCY FOR ANY REASON IS TRANSITIONED TO UN-FRACTIONATED HEPARIN DURING LABOR/DELIVERY TO ALLOW FOR QUICK REVERSAL.)
MODERATE HYPERMAGNESEMIA (SERUM LEVEL4.8-7.2 mg/dL) CAN INHIBITS THE RELEASE OF ___, CAUSING THIS SECONDARY ELECTROLYTE DISTURBANCE.
WHAT IS INIBITION OF PTH RELEASE CAUSING HYPOCALCEMIA?
(TYPICALLY ASYMPTOMATIC IN THE ACUTE SETTING (E.G., MG INFUSION FOR PRE-ECLAMPSIA). LONG TERM, HYPER-MG CAN CONTRIBUTE TO RENAL OSTEODYSTROPHY IN THE SETTING OF KIDNEY DISEASE.)
THESE FOUR ORAL AGENTS CAN BE USED TO TREAT MRSA SKIN/SOFT TISSUE INFECTIONS.
(NAME ALL FOUR, PLEASE!)
WHAT ARE BACTRIM, DOXYCYCLINE, CLINDAMYCIN, AND LINEZOLID?
WE ALL KNOW DR. MOWREY'S HALLMARK PHRASE, "NO BP, NO PEEPEE!" HE ALSO WANTS YOU TO KNOW THAT THIS CLASS OF MEDICATION WAS ONE OF THE FIRST TREATMENTS FOR DIABETES. USED SINCE 1835, IT WAS ORIGINALLY MADE FROM THE BARK OF GREEN APPLE TREES.
WHAT ARE SLGT2-INHIBITORS?
A 33 YO WOMAN WITH HYPERTHYROIDISM PRESENTS WITH PANCYTOPENIA. BONE MARROW BIOPSY SHOWS PROFOUDLY HYPOCELLULARITY AND MARROW SPACE COMPOSED MOSTLY OF FAT CELLS, POINTING TOWARDS THIS DIAGNOSIS.
WHAT IS APLASTIC ANEMIA?
(AA IS MOST COMMONLY CAUSED BY AUTOIMMUNE INJURY TO HSC'S BUT CAN ALSO BE TRIGGERED BY MEDICATIONS (ANTITHYROID, BETA-LACTAM ABX, SULFONAMIDES, NSAID, ANTI-SEIZURE, GOLD SALTS), AND INHERITED GENETIC SYNDROMES).
IN HEYDE SYNDROME AORTIC STENOSIS CAUSES TURBULENT FLOW THAT BREAKS DOWN THIS SUBSTANCE, PREVENTING PROPER CLOTTING AND LEADING TO BLEEDING.
WHAT IS VON WILLEBRAND FACTOR?
(HEYDE SYNDROME IS CHARACTERIZED BY THE TRIAD OF AS, GIB SECONDARY TO ANGIODYSPLASIA, AND ACQUIRED VON WILLEBRAND SYNDROME.)
GRANULOMATOUS INVASION OF CNS STRUCTURES IN THE SETTING OF NEURO-SARCOIDOSIS CAUSES THIS ELECTROLYTE DISTURBANCE.
WHAT IS HYPERNATREMIA?
(GRANULOMATOUS CNS DISEASE INFOLVING THE HYPOTHALAMUS/PITUITARY REGION LEADS TO CENTRAL DIABETES INSIPIDUS.)
A 63 YO MALE WITH ESRD ON PD PRESENTS WITH ABDOMINAL PAIN AND FEVER. PERITONEAL FLUID ANALYSIS REVEALED THESE TWO FINDINGS THAT PROMPTED ID TO START EMPIRIC INTRAPERITONEAL VANCOMYCIN/CEFTRAZIDIME.
WHAT ARE WBC >100 CELLS/MM^3 AND >50% NEUTROPHILS?
(REMEMBER TO START ANTI-FUNGAL PROPHYLAXIS WITH FLUCONAZOLE FOR PD PATIENTS TREATED WITH ABX FOR >3 DAYS!)
DR. SHAVER SAYS THIS MEDICATION USED IN THE TREATMENT OF WOLF PARKINSON WHITE SYNDROME IS KNOWN TO PRECIPITATE DRUG INDUCED LUPUS.
WHAT IS PROCAINAMIDE?
IN THE SETTING OF RENAL CRISIS, PATIENTS WITH THIS DISORDER SHOULD BE TREATED WITH ACE INHIBITORS, EVEN IN THE PRESENCE OF A RISING SERUM CREATININE LEVEL.
WHAT IS SYSTEMIC SCLEROSIS?
(ADJUNCTIVE THERAPY WITH PLASMA EXCHANGE HAS BEEN SUGGESTED IN THE SETTING OF MICROANGIOPATHIC FEATURES. ARB'S SHOULD BE CONSIDERED ONLY WHEN ACEI-I'S ARE NOT BEING TOLERATED.)
PATHOGNOMONIC PLAQUE-LIKE DEPOSITS OF FIBROUS TISSUE OCCUR MOST COMMONLY ON THESE TWO VALVES IN CARCINOID HEART DISEASE.
WHAT ARE THE TRICUSPID AND PULMONIC VALVES?
(LEADING TO TS/PS. CARCINOID HEART DISEASE AFFECTS THE LEFT SIDE OF THE HEART IN <10% OF CASES, DUE TO INACTIVATION OF HUMORAL SUBSTANCES BY THE LUNG.)
ALSO KNOWN AS "TURP SYNDROME," THIS ELECTROLYTE DISTURBANCE OCCURS DUE TO BLADDER IRRIGATION WITH GLYDINE DURING UROLOGIC/GYNECOLOGIC PROCEDURES.
WHAT IS HYPERTONIC HYPONATREMIA?
(GLYCINE BASED FLUIDS ARE USED FOR IRRIGATION OF THE BLADDER/UTERUS MAINTAIN VISIBILITY. THIS CAN BE ABSORBED THROUGH THE VENOUS SINUSES AND RESULT IN CNS GABA INHIBITION AND PARADOXICAL NMDA POTENTIATION, LEADING TO HYPONATREMIA.)
A 55 YO FEMALE PRESENTS WITH ENTEROCOCCUS FAECALIS BACTEREMIA. TEE SHOWS A VEGITATION ON THE AORTIC VALVE. TREATMENT IS INITIATED WITH THESE TWO IV ANTIBIOTICS.
(NAME BOTH, PLEASE!)
WHAT ARE AMPICILLIN AND CEFTRIAXONE?
(E. FAECALIS IS NOT TYPICALLY SENSITIVE TO CTX. HOWEVER, WHEN AMPICILLIN BINDS TO AMP-C SITES, CTX IS ABLE TO BIND AND ACT, PROVIDING EXTRA COVERAGE IN E. FAECALIS ENDOCARDITIS)
"GET THE DANG RECTAL EXAM!" SAYS DR. SHUBIN. WHICH REMINDS ME, PATIENTS AT RISK FOR COLORECTAL CANCER DUE TO LYNCH SYNDROME SHOULD BE SCREENED FOR VARIENTS IN THIS GENE.
(HINT: RHYME TIME!)
WHAT IS EPCAM (EPITHELIAL CELL ADHESION MOLECULE)?
(LYNCH SYNDROME IS CHARACTERIZED BY GERMLINE VARIATIONS IN THE MMR GENES (MLH1, MSH2, MSH6, PMS2) OR EPCAM.)