Rate your expectations
Aorta know better
Eye see what you did there
FAFO: Wildlife edition
Gall of Duty
Final Jeopardy
100
A patient presents with palpitations that began 5 days ago. Their rhythm strip is shown below. Their blood pressure and mentation are normal. What medication should be administered first as part of initial treatment?
Calcium channel blocker eg diltiazem
Beta blocker eg metoprolol
100
When managing an acute aortic dissection, which medical therapy should be initiated first?
Esmolol
100
A patient presents with the sudden onset of a painful red eye. What would be diagnostic for an acute angle-closure glaucoma attack?
Elevated IOP greater than 20mmHg
100
A 32-year-old man presents after a witnessed bite by a brown recluse spider. He is asymptomatic, with normal vital signs and a small area of erythema at the bite site. What is the most appropriate action/disposition?
Discharge with return precautions
100
This chronic hematologic disease featuring vaso-occlusive crises predisposes patients to form pigmented gallstones due to ongoing hemolysis?
Sickle cell disease
200
A 76-year-old woman presents with shortness of breath, fever, and a productive cough for 2 days. EKG shows new atrial fibrillation with a rapid ventricular rate. Her vitals signs are BP 109/76, P 140, R 24, and T 38.9oC; SpO2 94% on RA. She has received a fluid bolus. What is the next appropriate step in management?
Give antibiotics eg ceftriaxone and azithromycin for presumed pneumonia
200
In a patient with a known repaired abdominal aortic aneurysm, a secondary aortoenteric fistula most commonly forms between the aorta and what part of the intestine?
Duodenum
200
An elderly patient presents with suspected central retinal artery occlusion and jaw claudication and is found to also have an elevated ESR. What therapy should be started?
Methylprednisolone
200
What is the appropriate treatment for stingray envenomation?
Hot water immersion
200
What isolated finding is a common presentation of acute cholangitis in elderly patients?
Hypotension
300
A 58-year-old man with a history of myocardial infarction and heart failure presents in arrest with the below EKG. Which vasoactive medication that acts on different receptors in a dose dependent fashion is most likely to harm the patient?
Dopamine
300
Which murmur is most likely to be caused by an ascending acute aortic disseciton?
Early diastolic blowing murmur
300
In a stand-alone emergency department, a patient presents with monocular, painless vision loss, and a central retinal artery occlusion is suspected. To what sort of facility should this patient be transferred for what specialty(ies)?
Stroke center with both neurology and ophthalmology
300
A family presents after a bat was found in their child's room while asleep. The child does not recall being bitten, has no symptoms, and no bite wounds are found. What treatment, if any, is indicated?
Rabies post-exposure prophylaxis with rabies vaccine and human rabies immune globulin
300
What is a factor identified by the American Society of Gastrointestinal Endoscopy that would place a patient in an intermediate risk category of a common bile duct stone, and thus necessitate a MRCP instead of a ERCP (reserved for high risk patients)?
age greater than 55
abnormal liver function tests
dilated CBD on abdominal imaging
400
A 75-year-old woman presents with a decreased level of consciousness. Her vital signs are BP 70/40, P 40, R 12, and T 36.5oC. Her FSG is 114. Rhythm strip shown below. What is the most likely diagnosis?
Mobitz second-degree heart block, type II
400
Which factor places a patient at the highest risk for abdominal aortic aneurysm rupture?
Aneurysm diameter larger than 5.5cm
400
A 23-year-old man with a history of sickle cell disease presents with blurred vision after a ball hit his eye. A physical examination is shown below, and IOP is 30 mmHg. Which medication commonly given for this condition is contraindicated in this patient?
Acetazolamide or Carbonic anhydrase inhibitor
400
A 3 year old girl presents with acute foot pain that started while she was walking barefoot in the backyard. Her vital signs are BP 90/palp, P 176, R 36, and T 38.1oC; SpO2 is 97% on RA. On examination, she appears restless and ataxic, excessive oral secretions, jerking muscular movements, and rapid wandering eye movements are noted. No abnormality is seen on her foot. Envenomation by which creature is most consistent with this presentation?
Bark scorpion
400
Which antibiotic(s) should be given for acute perforated calculous cholecystitis?
Piperacillin-tazobactam
OR
Metronidazole PLUS Ceftriaxone OR Cefepime OR Levofloxacin
OR
Ertapenem
Can add Vancomycin if MRSA concern
500
You receive a call for medical direction for possible STEMI. The patient's EKG is shown below. Aspirin and IVF have been given. BP is 90/60, and the paramedic on site is requesting additional orders. Which out-of-hospital intervention would be the best first line treatment?
Atropine
500
A woman presents with severe, acute-onset chest pain radiating to the back as well as nausea and vomiting. On examination, she has asymmetric pulses, a diastolic murmur, and a unilateral facial droop with pronator drift. Her vital signs are notable for a 40 mmHg difference between BPs taken from each arm. She is noted in the chart to have anaphylaxis to iodinated contrast dye. What is the next most appropriate imaging modality to diagnose this condition?
Transesophageal echocardiography
500
A 32-year-old woman presents with the below finding. She reports eye pain, photophobia, and blurred vision, but denies tearing, discharge, and headache. On examination, she has a constricted pupil that is poorly reactive to light. Intraocular pressure in both eyes is 12 mmHg. What is the most likely diagnosis?
Anterior uveitis
500
You are in Hawaii. A patient presents with severe muscle spasms, diaphoresis, hypertension and a sensation of impeding doom after swimming in the water with an apparently minor sting. What syndrome should you suspect?
Irukandji syndrome
500
A 72-year-old man presents with severe right upper quadrant abdominal pain radiating ot his back. He has type 2 diabetes mellitus but no recent illness or surgery. Exam reveals fever and tachycardia with tenderness in the right upper quadrant but no peritoneal signs. There is no jaundice, and the pulmonary exam is unremarkable. Abdominal XRs are obtained. What is the most likely diagnosis?
Emphysematous cholecystitis
500
What organism is responsible for this poisoning OR what is the name of the toxin responsible?
Zoanthid corals OR palytoxin