Rheum with a View
A Bloody Good Time
The End is Near
The Internist's Blind Spot
Auscultation Station
100
A violaceous periorbital eruption—often accompanied by facial or eyelid edema—is a classic cutaneous finding of this idiopathic inflammatory myopathy.
Dermatomyositis
100
This is the recommended anticoagulant in patients with APLS.
What is warfarin?
100
This prognosis timeframe is required to meet hospice eligibility.
What is 6 months?
100
Name one topical treatment for bilateral, red, itchy eyes with clear discharge and preserved vision.
What is topical anti-histamines (ketotifen, olopatadine) or mast cell stabilizers (cromolyn)?
If refractory, can try topical steroids.
Systemic anti-histamines may also provide some benefit and may be reasonable to try before a topical medication especially if other allergic symptoms present.
100
This is the classic murmur sound created by aortic stenosis.
What is crescendo-decrescendo?
200
Nail lesions such as nail pits, onycholysis, nail bed hyperkeratosis, and splinter hemorrhages occur in 80-90% of patients with this arthropathy.
Psoriatic arthropathy
200
This DOAC requires the highest amount of renal clearance.
Dabigatran (80% renal clearance)
200
This is the name of the palliative communication framework that is best used when continuing goals of care conversations following your initial conversation.
What is REMAP?
200
This eye pathology is characterized by severe pain and a fixed, mid-dilated pupil.
What is acute angle closure glaucoma?
200
This adult congential heart defect causes a continuous, machinery like murmur best heard beneath the L clavicle.
What is a PDA?
300
DAILY DOUBLE
Your patient with frequent dental caries presents with this persistent, painless physical exam finding shown below, which malignancy are you most concerned about.
What is extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)?
300
This is the apixiban dosing regimen for 85 year old female with CKD3 (baseline Cr 1.8) who was diagnosed with DVT.
Apixiban 10 mg BID for 7 days, followed by 5 mg BID for 3-6 months
You reduce to 2.5 mg BID for Afib stroke prophylaxis if you meet 2 of the 3 following criteria: 1) age >/= 80 years, 2) body weight </= 60 kg, 3) Cr >/= 1.5)
300
Name three services that are not covered under hospice insurance benefits.
What are rehab therapies, IV therapies, labwork, imaging, 24/7 care, room and board?
300
Name this eye condition.
What is anterior uveitis?
Look for the ciliary flush
300
Name one location where aortic regurgitation can best be heard.
What is RLSB or LLSB?
400
This is the treatment for granulomatosis with polyangiitis.
What is steroids + rituximab OR cyclophosphamide?
400
This anticoagulant is the only recommended anticoagulation in patients with severe liver disease (i.e. Child Pugh Class C).
Warfarin
All DOACs are contraindicated in severe liver disease
400
Name three out of the four levels of hospice care.
What are routine care, general inpatient, continuous care, and respite care?
400
DAILY DOUBLE
Name this diagnosis.
What is HSV keratitis?
Consult ophtho and treat with topical antiviral.
400
This systolic murmur is characterized by a fixed split S2.
What is an atrial septal defect?
Fixed split because L to R shunt balances any preload variation caused by inspiration.
The drop in normal blood return during expiration is matched by an increase in shunt blood, keeping total right ventricular volume steady
500
This antibody is associated with limited cutaneous systemic sclerosis and this antibody is associated with diffuse cutaneous systemic sclerosis.
What is anti-centromere (limited) and anti-scl-70 AKA anti-DNA topoisomerase (diffuse)?
Limited is associated with CREST syndrome and development of pulmonary hypertension more commonly.
Diffuse is more commonly associated with development of ILD and scleroderma renal crisis.
500
This is the treatment for a patient on warfarin who has an INR > 10 and is not bleeding.
What is hold warfarin and administer high dose ORAL vitamin K (2.5-5 mg)?
500
When switching a patient from one opioid to a different opioid whose pain was well controlled, this is the percentage by which the calculated equianalgesic dose should be reduced to account for incomplete cross-tolerance.
What is 25% to 50%?
500
Your patient presents with a swollen eye, painful eye movements, and mild proptosis seen below. This is the initial empiric treatment.
What is vancomycin, ceftriaxone, and flagyl OR vancomycin and unasyn? You must cover MRSA/gram positives, gram negatives, and anaerobes.
Ophthalmology should be consulted.
If refractory - repeat imaging is indicated and surgery may be indicated to biopsy (to identify pathogen) and drain abscess if present.
500
This holosystolic murmur, best heard at the LLSB, creates this deviation from normal in the below RA/CVP waveform.
What is c and v fusion (blunting of x descent)?
Triscuspid regurgitation. During ventricular systole, ventricular blood flows backwards into the RA, preventing RA pressure from dropping normally.
