Endocrine
Cardiology
Electrolytes
ID
Final Jeopardy
100
What class of medications can cause Euglycemic DKA?
SGLT-2
100
What is the most common cause of acute endocarditis
Staphylococcus aureus.
HACEK group of organisms: Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella.
Prosthetic valve S. epidermidis more common
100
What is the reference range for Sodium and Potassium?
Na : 136 - 145
K : 3.5 - 5.1
100
You admit a patient for CAP, what abx regimen do you want to start?
Ceftriaxone + Azithyrmycin OR Doxy
200
What is the goal glucose level in hospitalized non-ICU patients?
140 - 180
200
Name that rhythm... and treatment!
Supraventricular tachycardia (SVT)
- try vagal maneuvers
- Adenosine 6mg -> 12mg
- If refractory: Call cards! Cardioversion if unstable
200
Your patient's potassium is 3.0 on AM labs and you want to replace it, what options do you have, and how much should you give?
Potassium Chloride pills (big), Potassium chloride oral solution (tastes bad), potassium chloride IV (takes forever to run, burns)
You should give at least 40 mEq to get their level close to normal range
200
A very common side effect of this medication is a metallic taste. This should also not be taken with alcohol.
Metronidazole?
300
Your patient has hypothyroidism and takes 100 mcg of Synthroid daily. She is currently NPO due to aspiration risk pending speech eval. What do you do?
- If for a day or two, probably ok to hold med
- If prolonged NPO, consider NG tube and deliver all meds per tube (that can be given per tube)
- IV Synthroid: 1/2 (ish) the PO dose daily
300
Common cause of young person to go into tachydysrhythymia + only having high blood pressure in the hospital or clinic
What is Wolff-Parkinson-White Coat Syndrome
300
A patient is admitted for hyponatremia. List 3 medications/classes of meds that could be causing their low sodium.
Diuretics (mostly thiazides)
Seizure meds: carbamazepine, valproate, lamotrigine
Psych meds: SSRI's, TCA's, Venlafaxine, Antipsychotics
Desmopressin, oxytocin, vasopressin
Opiates, PPI's, Amiodarone, NSAIDs, Linezolid, Illicit drugs (MDMA, ecstasy)
300
Patients on this class of medications should avoid sunlight exposure as much as possible. It can also tooth discoloration in children.
Tetracyclines (tetracycline, doxycycline, minocycline)
400
You're working on an admission med rec for a 62 yo female with DM2. Her last A1C was 9.6 five weeks ago. Her home diabetes medications are:
Lantus 60u QHS
Metformin 1000mg BID
Trulicity 3mg qWeek
What would you like to do to manage her diabetes while she is admitted?
Hold Metformin - risk of lactic acidosis when acutely ill (?)
Hold Trulicity
Continue Lantus, reduce the dose by ~ 20% (more if NPO, decreased PO intake), consider starting SSI with meals if uncontrolled
400
You get a page about a floor patient that you're cross covering. 67 yo female here for sepsis, she's complaining of palpitations. Vitals are stable. You get an EKG and it shows the following. What would you like to do?
Afib with RVR
- If stable: IV metoprolol 5mg or Dilt 10-20mg (if no known CHF)
- Not stable: call cards! Amio drip/cardioversion
- Will need TTE, discuss anticoagulation
400
You get a call on nights that your patient is hyperkalemic to 6.0. Your senior is sleeping and you don't want to wake them, what do you do?!
Check to see if sample is hemolyzed
eval the patient!
EKG/tele
tx: lokelma, insulin + dextrose, calcium gluconate
400
What single agent is the preferred empiric treatment for a cat bite, which can be polymicrobial but can often contain the gram-negative coccobacillus Pasturella multocida.
Augmentin; Amoxicillin/clavulanate
If penicillin allergy, can use combination therapy with Doxycycline and Metronidazole
500
You are seeing a potential admit in the ED. They have a blood glucose of 540, elevated beta-hydroxybutyrate, an anion gap of 24, and pH on ABG is 7.27. What is wrong with them, and what are you going to do?
DKA protocol
- insulin drip (cont until gap closed x at least 2)
- fluids
- NPO
- q4-6hr BMPs for K monitoring w/ replacement
- figure out why they're in DKA
500
What are the four pillars of GDMT (and name a medication from each drug class)
What are:
Beta Blockers (Metoprolol succinate, carvedilol, bisoprolol)
ACE/ARB/ARNI
MRA (spiro, eplerenone)
SGLT2 (Dapagliflozin, Empaglaflozin)
500
A patient presenting for dehydration due to diarrheal illness is found to have a Na of 154 on admission.
What is your goal Na over the next 24 hrs and how are you going to get them there?
What are you worried about if you drop it too fast?
-Hypernatremia likely due to GI losses in this case. If acute, probably ok to drop Na a little faster, but if chronic, or unknown timeline, goal is to drop Na by no more than 8-10 mmol/L over 24 hrs (0.5 mmol/hr)
- calculate pt's Free water deficit -> best to try PO fluid intake, but if not tolerating, IV fluid resus can be used.
- If you drop the Na too fast your pt can develop Osmotic demyelination syndrome AKA central pontine myelinolysis, this occurs when the myelin sheath around nerve cells in the brain is destroyed. Symptoms include muscle weakness, paralysis, difficulty speaking, and behavioral changes.
500
Vancomycin must be infused slowly to prevent this side effect from occurring.
Bonus - what causes is to happen?
Red man syndrome? Flushing and/or an erythematous rash that affects the face, neck, and upper torso.
It is due to mast cell degranulation.
500
This person received a presidential citation in 1955, and was given the nickname "The Man who saved the children"
Dr. Jonas Salk - inventor of the Polio vaccine!