Labs
Blood marker used to diagnose GCA..
ESR
What should you order after insertion of central line ..
CXR
A middle-aged man has pancytopenia, splenomegaly, and dry tap on bone marrow aspiration. What stain confirms the diagnosis?
TRAP (tartrate-resistant acid phosphatase) — diagnostic of hairy cell leukemia
A patient treated for TB develops red-orange discoloration of urine and tears. Which drug is responsible?
Rifampin
A patient receiving chemotherapy for ALL develops tumor lysis syndrome with hyperkalemia, hyperphosphatemia, and rising creatinine. What drug should be given emergently?
Rasburicase (for uric acid degradation) — not allopurinol in established TLS
Patient on daptomycin you have to check ..
CK
Radiology finding on Aortic dissection ? (CXR)
mediastinal widening
A 45-year-old woman presents with proximal muscle weakness, Gottron’s papules on her hands, and elevated CK. Her chest CT shows ground-glass opacities. What underlying diagnosis should be suspected?
Dermatomyositis with interstitial lung disease (consider paraneoplastic workup)
A patient with AIDS presents with multiple ring-enhancing lesions in the brain. Empiric therapy is started, but MRI shows no improvement after 2 weeks. What’s the next diagnostic step?
Brain biopsy (to rule out CNS lymphoma)
Treatment of PJP (Pneumocystis jirovecii pneumonia) ?
Septra (TMP-SMZ)
When start patient on methimazole you have to monitor ..
Liver enzymes
What type of contrast should be used in patients with suspected esophageal perforation?
Water-soluble contrast (e.g, Gastrografin), not barium
A patient with history of DVT develops skin necrosis 3 days after starting warfarin. What underlying deficiency should be suspected?
Protein C deficiency
A patient with TCA overdose has QRS widening on EKG. What is the antidotal therapy?
IV sodium bicarbonate bolus
CSF culture grew pseudomonas aeruginosa
Ceftazidime & intravenous aminoglycoside (like tobramycin or amikacin) to the initial regimen, especially for critically ill patients, to improve outcomes
A pregnant lady in her 27 weeks of gestation presented with BP of 155/92 you have to order ..
Urine protein
On CT abdomen, you see pneumatosis intestinalis and portal venous gas in a hypotensive patient. What diagnosis must be urgently ruled out?
Bowel ischemia with infarction
A returning traveler from India presents with fever, relative bradycardia, and rose spots on the abdomen. Widal test is positive. What is the diagnosis?
Typhoid fever (Salmonella typhi infection)
A 25-year-old presents with chest pain and ST elevation in leads V1–V3 but normal coronaries on angiogram. What is the diagnosis?
Brugada syndrome
A patient ingests methanol and presents with visual disturbances and acidosis. What is the treatment of choice?
IV fomepizole (or ethanol), supportive care, and urgent hemodialysis
Calculate Osmolar gap
Serum Osmolality :306
Na:142 ,Cl : 95 , K 3.8 , BUN : 8 , Glu :5
[calculated osm: 2xNa + Gluc + BUN]
Osm Gap = 306-((142x2) + 8 + 5) =9
In a mechanically ventilated ICU patient, the chest X-ray shows lucency outlining the heart and mediastinum with the “continuous diaphragm sign.” What does this indicate?
Pneumomediastinum
A young woman presents with recurrent pneumothorax and diffuse cysts on CT chest. What rare diagnosis should be considered?
Lymphangioleiomyomatosis (LAM)
A sheep farmer presents with fever, pneumonia, and elevated liver enzymes. What zoonotic infection should you consider?
Coxiella burnetii (Q fever)
A 62-year-old with NSTEMI and new creatinine 2.8 mg/dL is scheduled for PCI. What antiplatelet should be avoided pre-procedure?
Prasugrel — contraindicated in renal dysfunction and increased bleeding risk before PCI planning.
(Alternative: Clopidogrel or ticagrelor preferred.)