Em Inservice Guess The Diagnosis

Front 1

Guess the diagnosis?
-39F
-Fever
-Cr bump
-hemolytic anemia
-thrombocytopenia
-neurologic complaint

Back 1

-TTP (they probably won't give you all 5)
-Clues are pregnant, recent infection, HIV, SLE, or new drug
-Tx with daily plasma exchange & supportive care
- +/- steroids, splenectomy depending on the cause

Front 2

Guess the diagnosis?
-23yo man
-Non-healing cellulitis
-Abscess or satellite lesion present
-Finished a 5 day antibiotic course

Back 2

-Likely community acquired MRSA
-Prisoner or athlete is a big clue
-TMP-SMX is appropriate & cost effective (vanc & linezolid are BIG guns, effective but overkill)

Front 3

Guess the diagnosis?
-40 yo man
-Tender, warm, swollen, erythematous joint
-Takes HCTZ for HTN
-Few systemic complaints

Back 3

-Gout vs pseudogout
-ETOH is big clue if they give it
-Negative birefringement urate crystals = gout
-Positive birefringement calcium pyrophosphate crystals = pseudogout

Front 4

Guess the diagnosis?
-83 yo man with HTN & DMII
-Sudden onset left sided hemiparesis & Left hemisensory changes
-Note: What happened and where?

Back 4

-Internal capsule intracerebral hemorrhage
-These are the lenticulostriate arteries that burst with HTN

Front 5

Pain with EOM, decrease visual acuity, proptosis and opthalmoplegia?

Back 5

Orbital cellulitis

Front 6

What smells are associated with:
1. Cyanide
2. Zinc
3. Tolulene
4. Organophosphate, arsenic, and selenium
5. Hydrogen Sulfate

Back 6

1. Cyanide = Almonds
2. Zinc = Fishy
3. Tolulene = Glue
4. Organophosphate = Garlic
5. Hydrogen Sulfate = Rodent Eggs

Front 7

Severe poison ivy contact dermatitis (i.e. the whole leg) is treated with?

Back 7

14 day ORAL steroid course, benadryl for itching and cool compresses

Front 8

What is Cushing's triad and what does it suggest?

Back 8

Cushing's triad : widening pulse pressure (i.e. sky high SBP), irregular breathing, and a reduction of the heart rate.

Suggests ICP or imminent herniation

Front 9

What is Cushing's triad and what does it suggest?

Back 9

Cushing's triad : widening pulse pressure (i.e. sky high SBP), irregular breathing, and a reduction of the heart rate.

Suggests ICP or imminent herniation

Front 10

T or F: It is normal for pregnant women have RLQ pain in the second and third trimesters?

Back 10

True. More than 50% of pregnant women without appy''s have RLQ pain.

Front 11

What is the target SBP for
1. Ischemic Stroke
2. Hemorrhagic Stroke

Back 11

1. Don't lower BP in ischemic stroke unless pt is a tPA candidate or has concomittant MI/dissection/renal failure. High BPs are neuroprotective in this case.

2. Goal SBP s/p hemorrhagic stroke is 140-160 mmHg

Front 12

66yo F smoker, fatigue, dizzy, Na = 112

Back 12

SIADH likely d/t small cell lung CA

Front 13

Healthy pregnant lady gives birth normally and then goes into septic shock w/ DIC?

Back 13

Amniotic fluid embolism (rare. amniotic fluid enters bloodstream and causes whole body immune response)

Front 14

Young woman with viral illness and later has tender, oval shaped, non-itchy rash on her shins.

(Bonus for treatment)

Back 14

Erythema nodosum usually 2/2 strep pneumo or sarcoid.

This is a hypersensativity rxn and treatment is NSAIDs / ASA.

Front 15

Man stops taking lithium then gets febrile, tachycardic, and wide pulse pressure?

Back 15

Thyroid storm (lithium has inhibitory effect on release of T4 and abrupt cessation can cause T4 flood)

Front 16

18 mon old has water stools with no WBCs in the stool in January?

Back 16

Rotavirus

Front 17

Any age with coughing, wheezing, absent breath sounds?

Back 17

Foreign body aspiration

Front 18

AML pt with weakness, neuro symptoms, and mucosal bleeding?

(Bonus for tx?)

Back 18

Hyperviscosity syndrome (too many proteins in their blood, treat with plasmapheresis)

Front 19

Pt has a digit with symmetric swelling throughout, volar tenderness of the digit, keeps digit flexed and has pain when passively extended.

Back 19

Flexor tenosynovitis (Kanavels four cardinal signs).

IV Abx and hand surgeon consult for possible drainage.

Front 20

Pt puts their hand somewhere and get a pinprick followed by muscle cramps 1 hour later and then a rigid abdomen after that.

Back 20

Black widow bit

Supportive care in adults, monitor for signs of CV collapse in kids

Front 21

Male smoker with pneumonia presentation AND GI symptoms?

(Bonus: How is dx confirmed?)

Back 21

Legionella PNA (Gram - bacillus, ? stem may include hyponatremia, elevated LFTs, or neuro symptoms)

Diagnosis made by testing urine for antigens

Front 22

Exertional dyspnea, chest pain, syncope

Back 22

Aortic Stenosis (systolic murmur to the neck)

Front 23

Acute MI with new aortic regurge

Back 23

Ascending aortic dissection until proven otherwise

Front 24

CHF picture with loud holosystolic murmur

Back 24

Mitral regurge

Front 25

STEMI in 3rd trimester pregnancy

Back 25

Ascending aortic dissection until proven otherwise

Front 26

Waterhammer pulse and Austin Flint murmur

Back 26

Aortic regurge

Waterhammer pulse = widened pulse pressure

Austin-Flint murmur = double rumble as blood hits MV leaflet and the LV wall

Front 27

Exertional dyspnea, chest pain, syncope

Back 27

Aortic Stenosis (systolic murmur to the neck)

Front 28

Acute MI with new aortic regurge

Back 28

Ascending aortic dissection until proven otherwise

Front 29

CHF picture with loud holosystolic murmur

Back 29

Mitral regurge

Front 30

STEMI in 3rd trimester pregnancy

Back 30

Ascending aortic dissection until proven otherwise

Front 31

Waterhammer pulse and Austin Flint murmur

Back 31

Aortic regurge

Waterhammer pulse = widened pulse pressure

Austin-Flint murmur = double rumble as blood hits MV leaflet and the LV wall

Front 32

Stable pt has wide complex tachycardia with delta wave (bonus for tx)

Back 32

WPW (may be too tachy to tell its wide)

Treat with procainimide (sync and cardiovert if unstable)

Front 33

J-wave on EKG

Back 33

Hypothermia

Front 34

Otherwise healthy male smoker with no lab abnormalities has painful, friable gingiva w/ intermittent fevers?

Back 34

ANUG (acute necrotizing ulcerative ginginvitis)

Front 35

Pt with past AAA graft repair has rectal bleed and abd pain?

(Bonus: cause? Work-up?)

Back 35

Aortoenteric fistula until proven otherwise.

Caused by S. Aureus or E. Coli on the graft site.

Needs esophagogastroduodenoscopy

Front 36

Kid with fever that resolved then gets generalized macular rash 4 days later?

Back 36

Roseola

Front 37

Scrotum with blue dot?

Back 37

Testicular APPENDAGE torsion