Intern School Jeopardy

Rheum

100

Name 3 pharmacological treatments for Osteoarthritis

Pharmacologic treatment includes:

• NSAIDs; consider topical NSAIDS before oral NSAIDs in knee and hand OA but not hip OA
• duloxetine (has shown efficacy for pain from knee OA)
• tramadol; considered in limited circumstances if other treatments are contraindicated or ineffective
• intra-articular glucocorticoids for acute exacerbations of knee OA

200

Antibody used to help diagnose drug induced lupus erythematosus 

antihistone body

300

What is the target uric acid level for urate lowering therapy in gout?

The American College of Rheumatology and European League Against Rheumatism support a “treat-to-target” approach, reducing the serum urate level to less than 6.0 mg/dL.

Allopurinol should be avoided in high-risk populations (Han Chinese, Taiwanese, Korean, African patients) if positive for HLA-B*58:01.

400

Name 3 small vessel vasculitis conditions

Granulomatosis with polyangiitis, Microscopic polyangiitis, Eosinophilic granulomatosis with polyangiitis, IgA vasculitis (Henoch-Schönlein purpura), Hypersensitivity vasculitis (leukocytoclastic vasculitis), Cryoglobulinemic vasculitis, Behçet syndrome

500

The presence of Gottron papules (scaly, purplish papules and plaques over the metacarpal and interphalangeal joints) or a heliotrope rash (edematous lilac discoloration of periorbital tissue) is virtually diagnostic of dermatomyositis.

GI

100

2 most common causes of Peptic Ulcer Disease?

NSAIDs and H. pylori

200

When should antibiotics and PPI's be discontinued to avoid a false negative H. pylori test?

up to 28 days for antibiotics and 2 weeks for PPI's

300

1st line treatment approach for GERD?

In patients without alarm features (anemia, dysphagia, vomiting, weight loss), GERD management consists of once-daily PPI for 8 weeks; twice-daily PPI for 4-8 weeks is indicated in patients not responding to once-daily treatment.

If still having persistent symptoms, referral to GI for EGD. 

400

3 medications most commonly associated with causing microscopic colitis.

Treatment for microscopic colitis?

PPI

SSRI

NSAIDs

Tx: discontinue agent, antidiarrheal meds, budesonide 

500

Describe the Forrest Classification for Ulcers

• Forrest Ia: Active spurting hemorrhage
• Forrest Ib: Active oozing hemorrhage
• Forrest IIa: Non-bleeding visible vessel
• Forrest IIb: Adherent clot
• Forrest IIc: Flat pigmented spot on the ulcer base
• Forrest III: Clean ulcer base without signs of recent bleeding 

Pulm

100

First step in assessment of someone with reported uncontrolled asthma prescribed inhalers.

Assess inhaler technique. 

200

What is your expected pulse ox range for a patient with carbon monoxide poisoning or cyanide toxicity?

Normal. Limitations of pulse ox technology in differentiating between oxyhemoglobin and other hemoglobin species such as carboxyhemoglobin and methemoglobin. 

Cyanide inhibits cytochrome oxidase in the mitochondria, preventing cellular utilization of oxygen and leading to tissue hypoxia. Pulse ox can remain normal bc arterial oxygen content is not directly affected by cyanide, the issue arises in the cellular utilization of oxygen. 

300

What is the laboratory test to rule out active TB?

AFB sputum cultures and smears! Sputum may be obtained spontaneously (by coughing) or it may be induced. A series of at least 3 single specimens should be collected in 8- to 24-hour intervals (with at least one specimen obtained in the early morning). Obtaining three specimens is useful for culture even if the first or second specimen is smear positive.

400

In a critically ill patient, when should you start enteral feeding?

When should you consider TPN?

Initiation of enteral nutrition is recommended at 24 to 48 hours following admission. 

For patients who cannot tolerate enteral feeding, total parenteral nutrition should not be started before day 7 of an acute illness.

500

Name of trial that showed Apixaban is noninferior to LMWH and vitamin K antagonist-based therapy for VTE recurrence and VTE mortality. 

AMPLIFY Trial 2013: Apixaban is noninferior to LMWH and vitamin K antagonist-based therapy for VTE recurrence and VTE mortality. Apixiban therapy has a greater reduction in rates of bleeding.

Cards

100

The 4 GDMT medication classes for HFrEF

• 
  

  Angiotensin Receptor-Neprilysin Inhibitors (ARNIs): like sacubitril/valsartan

  Beta-blockers:such as carvedilol, metoprolol, or bisoprolol
  Mineralocorticoid Receptor Antagonists (MRAs): like spironolactone or eplerenone
  Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2i): like empagliflozin or dapagliflozin
  
  
  
  

200

Name 8 medications indicated for the treatment of ACS (acute coronary syndrome)

Aspirin, P2Y₁₂ inhibitor, Beta-Blockers, anticoagulation, ACE, ARB, Nitroglycerin, Statin, Eplerenone

300

Diagnostic criteria for severe aortic stenosis

Transaortic velocity equal/> 4.0 m/s

Mean pressure gradient equal/> 40 mm HG

Aortic Valve Area <1.0 cm²

400

What is the appropriate management of an Abdominal Aortic Aneurysm ranging 4.0-5.5 cm?

Abdominal U/S every 6-12 months. 

500

Case Scenario: 55 y/o with Afib on warfarin undergoing an elective cholecystectomy. INR 2.3. What should you do about anticoagulation and bridging therapy?

BRIDGE TRIAL: 

In patients with Afib who had warfarin treatment interrupted for an elective operation or other elective invasive procedure, forgoing bridging anticoagulation was noninferior to perioperative bridging with low-molecular-weight heparin for the prevention of arterial thromboembolism and decreased the risk of major bleeding.

Things James Likes

100

Favorite sports team

Auburn Tigers

200

Favorite Drink

Old Fashioned

300

Plant Dad! What 2 types of plants do I own which I treat as my own children?

Fiddle Leaf Fig and Monstera Deliciosa 

400

Name all 4 members of The Beatles

John, Paul, George, and Ringo

500

For $50! Name all 7 members of BTS!

Jungkook, J-Hope, Jimin, RM, V, Suga, and Jin

For an extra $25! What does BTS stand for? I'll take Korean or English