RU an Alpha or Beta Lactam?
No one else was in the Rheum where it happened..
A Grand Ol' Time
Boards and Beyonder
Allstar Ailments
100
Which is the portion of penicillin the cross reacts with beta lactams?
The R Group
100
You just diagnosed your patient with dermatomyositis! (or so you thought...); after treatment, what is it important to do follow-up testing for?
Malignancy screening
100
44 yoM evaluated for muscle cramps and fatigue. Frequently experiences cramps after prolonged exertion. Past few months has difficulty climbing stairs, unsteady walking. No FHx of neurologic dz.
PE: Vitals WNL. No muscle tenderness. Strength reduced proximally, preserved distally. Deep tendon reflexes preserved with delayed relaxation. Biceps percussion leads to raised muscular ridge. Waddling gait. Sensory exam is normal. No involuntary movements.
Most likely cause?
Hypothyroid myopathy
Typically symmetric proximal weakness, myalgia, and cramps
Muscle mounding (myoedema) and decreased DTR c/f hypothyroid
100
52 year old lady with PMH of HTN. What is the PE finding?
Xanthelasma
100
This actress suffers from this dysautonomic disease characterized by orthostatic intolerance with her HR increasing by >30/min, particularly while standing
Jameela Jamil
POTS
200
If my patient reports a penicillin allergy, I will use this clinical decision rule to evaluate their risk of positive penicillin allergy test
200
A patient with both proximal AND distal weakness would be concerning for which type of myositis?
Inclusion Body is classically associated with both proximal and distal weakness
200
What is the aldosterone paradox
Why all hypotensive patients (RAAS activated) don't have hypokalemia from aldosterone; reabsorb K later than the pathway
200
40 year old man with episodic dizziness. 3 years ago, developed L ear sensorineural hearing loss with tinnitus. For 6 months, had "room spinning" lasting from 30 minutes to several hours. A/w nausea and some vomiting. Has disequilibrium. MRI 6 months ago was normal. Not on meds. PE normal. Dix-Hallpike on L siide causes dizziness w/o veritgo or nystagmus. Dx?
Meniere Disease
200
This Hall of Fame baseball player developed this neurodegnerative disease with both upper and lower motor neuron symptoms which has since been named after him
Lou Gehrig
ALS (Lou Gehrig Disease) though he might have actually had CTE!
300
Name 3 cephalosporins that do NOT cross react with penicillin
300
Your patient with dermatomyositis is not responding well to steroids. What would be your next step up in treatment?
IVIG, rituximab, other immunologics
300
What is the "Potassium Switch"
Dietary K can act as a thiazide diuretic
300
34 yo M develops fever, malize, conunctivitis, cough, and a rash that started on his face and then became generalized as below. Dx?
Measles
300
This superstar suffers from a condition characterized by widespread chronic pain, fatigue, trigger points with otherwise normal labs or testing. What is the first line pharmacologic treatment option for this?
Lady Gaga
Fibromyalgia
Typically requires a multi-modal/holistic approach (exercise, education, psychosocial support). 1st line treatment includes pregabalin, duloxetine, milnacipran, TCA
400
You have 30 seconds to pull up the beta lactam cross reactivity chart on your phone
Residency Files -> Helpful Links -> ID Resources
400
Name 2 features that make a patient with dermatomyositis or polymyositis high risk for malignancy
- Age > 40
- Features of persistent disease activity despite immunosuppressive therapy
- Dysphagia
- Cutaneous necrosis or ulcerations
400
What was the main takeaway from the SSASS study?
A potassium enriched salt reduced the risk of CVA and MACE
400
65 year old male evaluated for single episode of gross hematuria that occurred 1 month ago. Hx of AFib with metoprolol and rivaroxaban. PE is normal other than irregular rhythm. UA is normal. US of the kidneys and bladder is normal. Next step?
Cystoscopy
A single incidental finding of hematuria is sufficient to warrant investigation into its cause
400
This actor, who has been experiencing worsening personality and behavioral changes, compulsive tendencies, a loss of empathy, and poor insight, might benefit from treatment with which class of medications for behavioral disturbances?
Bruce Willis
Frontotemporal Dementia
SSRIs have shown effectiveness in treating some of frontotemporal dementia symptoms, especially by decreasing the frequency of compulsive behaviors - first line for behavioral disturbances.
500
Monobactams (aztreonam) does not cross react with cephalosporins EXCEPT this one
Ceftazidime
500
Name that antibody association!
1. Anti-Mi-2
2. Anti-RNA Polymerase III
3. Anti-HMG-CoA Reductase
4. Anti-U1-RNP
5. Anti-Ro/La
1. Dermatomyositis
2. Diffuse Sclerosis
3. Immune mediated inflammatory myopathy
4. MCTD
5. Sjogren's
500
What enzyme does the grand round speaker's favorite candy inhibit?
11-beta-hydroxysteroid dehydrogenase type 2 in the kidney
Inactivates cortisol preventing it from binding MR in kidney, making aldosterone the primary regulator
500
What was the result of the MACRO trial for chronic azithromycin use in COPD patients?
Decreased frequency of acute exacerbations, colonization, and improved QOL BUT increased hearing loss and colonization of macrolide resistant organisms
500
This singer, who has fought a lifelong chronic multisystem inflammatory disorder requiring multiple steroid courses, could safely use this maintenance treatment if she desired pregnancy.
Halsey
Hydroxycloroquine
Most DMARDs contraindicated: mycophenolate, methotrexate, belimumab, cyclophosphamide.
Azathioprine, if absolutely necessary, can be continued, particularly if known nephritis.