Who You Gonna Call?
You Make My Heart Skip a Beat
POCUS Baby!
Doxycycline Deficiency
Itch Itch, Scratch, Scratch
The Flower City
100
You are taking over as the provider for a patient on hospital day 3 and the patient has had significant changes in their renal and hepatic function. They are on a LOT of medications. These providers are available to help adjust medication doses to account for these changes.
Who are pharmacists?
6th floor medicine units have an embedded pharmacist as does the emergency department, so ask them first for patients on those units. For all others, call 55212 and ask for the pharmacist covering "x" unit.
100
Name this rhythm and your next steps in care
What is asystole? Start CPR, call a code
100
This 75 year-old male with cirrhosis presents with abdominal pain and distension. Name the finding and a next step in care.
What is ascites?
Paracentesis - Diagnostic for SBP with abdominal pain
100
Doxycycline is the first line treatment for the condition characterized by the rash in the photo above.
What is Lyme disease?
100
Name this rash and one possible treatment modality.
What is urticaria?
Treatments vary based on severity of reaction:
- Airway involvement/anaphylaxis --> Epi
- PO/IV benadryl
- Cetrizine
- Topical benadryl for symptom control
100
There are more than 200 varieties of this flower in Highland Park and the namesake for one of Rochester's biggest Spring festivals.
What are lilacs?
200
You are the night float resident called to assess a 50 year-old with new onset chest pain. The nurses have obtained an EKG before you arrive to the floor. What is the diagnosis and who should you call?
Cardiology?
Diagnosis - STEMI
200
You are called to assess a patient with this rhythm on telemetry. Identify the rhythm and a potential treatment approach.
What is Afib with RVR?
Unstable - Shock
Stable - IV metoprolol, IV diltiazem (if no acute CHF)
Stable with lower BPs - IV digoxin
200
Identify one common cause of this ultrasound finding and the next steps in care?
Hydronephrosis
1. Urinary retention --> Foley
2. Obstructing stone --> Urology Consult
200
In addition to this other antibiotic, doxycycline is the first line treatment for CAP in non-immunocompromised adults.
What is ceftriaxone or cefpodoxime?
200
Commonly seen in the peri-oral region in children, name two common organisms which result in this condition.
What is Strep and Staph?
Dx - Impetigo
Rx - Mupirocin
200
This 351 mile long body of water connects the Hudson River in Albany to the Niagara River in Buffalo.
What is the Erie Canal?
300
You are on your first night of night float and a patient is having significant agitation and combative behaviors. You have utilized the PRN in the chart without much effect and nursing is looking to you for the next steps. This person can be a great resource at night (bonus if you know the phone number!)
Who is the R3 NF?
Phone: 64014
Other in-house help: Nocturnist - can be reached by pager or Epic chat (they want you to call!)
300
You are called to assess this 85 year-old who presented with vomiting and diarrhea. What is the rhythm and your next steps in care?
What is sinus tachycardia?
Assess for underlying causes of sinus tach. Here likely due to volume depletion.
- IVF bolus and assess for response
300
Name this structure and its pesky contents.
What is the gallbladder and gallstones?
300
In addition to the palmar and plantar rash, patients with this disease often present with high fevers, LFT abnormalities and hypotension.
What is Rocky Mountain Spotted Fever?
300
Name this finding in long-standing gout and therapies which could have been started ages ago to help minimize its formation.
What are tophi?
Rx --> Uric acid lowering therapies
- Allopuriol
- Febuxostat
- Steroids/NSAIDs/Colchicine in acute flares
300
This Rochester delicacy orignated at Nick Tahou's and is traditionally made with potatoes, hot dogs/burgers, mac salad and topped with hot sauce.
What is a garbage plate?
400
Mr. A is a 75 year-old male with severe OSA and HFrEF requiring BiPAP after an ICU stay for decompensated HFrEF with hypoxic and hypercarbic respiratory failure. He hates the BiPAP - it's loud, blows air into his eyes and hurts. This team of providers is available 24/7 to help troubleshoot, adjust masks and optimize settings.
Who is respiratory therapy?
RTs are available/covering all ICUs and ED and are also assigned to each unit. Nursing can help contact the correct RT for the unit.
Bonus - they can do ABG, trial different masks and optimize settings for BiPAP, CPAP, HFNC, etc.
400
Name this rhythm and a potential treatment option.
Torsades de Pointes.
If unstable - SHOCK
If stable - IV Mg
400
This structure and its compression (or lack of) can be used to assess a patient's volume status.
What is the IVC?
400
Doxycyline is an oral option to treat cellulitis or abscess secondary to this organism.
What is MRSA?
400
This condition can be difficult to treat and is characterized by tender subcutaneous nodules which can rupture or coalesce to form deeper abscesses.
What is Hidradenitis suppurativa?
Rx in the hospital --> Controlling local infections or super-infections with antibiotics, topical wound care.
Derm consult to assist with long-term management, immunosuppression
400
This Rochesterian founded Kodak and helped make Rochester the center of the film industry in the 1900's.
Who is George Eastman?
500
You are the cross cover resident and receive a call from radiology that your patient has a saddle PE and they refer you to an image to review. On arrival to the floor, your patient is hypotensive and tachycardic. Name this team which can provide multidisciplinary help right away while you start this class of medication.
Who is the PERT Team?
--> Cardiology, ICU, consideration for catheter-based or surgical therapy
Medication? LMWH or IV unfractionated heparin
URMC Acute PE guidelines from Policy Stat:
500
You are in the ICU and your patient becomes unstable with this rhythm. What is it and what are your next steps.
What is ventricular fibrillation?
Defibrillation ASAP but CPR until that time. Later steps in ACLS with epinephrine and amiodarone.
Pro tip - if the patient has this rhythm and is doing just fine, it's likely artifact, often from teeth brushing!
500
Mrs. S is a 54 year-old female who presents with fever and cough She has diminished breath sounds at the right base. Name the POCUS finding and the next steps in care.
What is a pleural effusion?
Next steps --> Thoracentesis for fluid analysis
500
A peripheral blood smear in this disease treated with doxycycline might reveal morulae in the cytoplasm of granulocytes. This disease is most common in the Northeastern and Midwestern states and is increasing in frequency in Rochester.
What is anaplasmosis?
500
This condition is often triggered by an infectious cause, usually HSV1 or HSV2 (Mycoplasma in kids for the MP folks!) or can be secondary to drug exposures from NSAIDs, anti-epileptics or sulfonamides.
What is erythema multiforme minor?
Rx: Time --> lesions typically resolve within 7 days
Erythema multiforme major --> Skin plus mucosa
Rx: Treat underlying trigger (antivirals for HSV, antibiotics for Mycoplasma) and systemic steroids.
500
Name the two famous Rochesterians this bridge is named after.
Who are Frederick Douglass and Susan B. Anthony - the Freddie-Sue Bridge!