Medical Jeopardy “Doctor’s Dilemma”
2001 ACP-ASIM Indiana Associates Scientific Meeting
All answers must be stated in the form of a question
Medical Jeopardy Category – “Age is in the Eye of the Beholder….” (Geriatric Medicine)
Value
100
200
300
400
500
The “ANSWER”
1.5 million Americans reside in this type of
setting.
This is defined as an elevated TSH, normal free
T3 and free T4 levels, and no clinical features
hypothyroidism
This term is applied to a patient in whom the
bone mineral density that is 2.5 standard
deviations below the peak bone mass of a
young woman between the ages of 25 and 30
AND who has experienced a previous fracture.
The CORRECT QUESTION
What is a nursing home?
Entrapment of the purely sensory lateral
femoral cutaneous nerve produces a syndrome
of anterolateral thigh anesthesia and/or
paresthesias.
According to Marshal Folstein, MD, when
administering the Mini-Mental State Exam to a
blind patient, the questionnaire should be
scored based on these many points. (i.e. the
score’s denominator).
What is meralgia paresthetica?
COMMENTS
What is subclinical hypothyroidism?
What is established osteoporosis?
What is 30?
4 items require sight – naming objects,
reading and obeying a written
command, sentence writing and
drawing overlapping pentagons.
“Osteoporosis” applies to only a BMD
loss of greater than 2.5 standard
deviations. The difference between
“osteoporosis” and “established
osteoporosis” is important because it
impacts on future fracture risks.
According to Dr. Folstein, extenuating
factors like blindness and illiteracy
should be noted; however, the MMSE is
always to be scored on the basis of 30
points.
Medical Jeopardy “Doctor’s Dilemma”
2001 ACP-ASIM Indiana Associates Scientific Meeting
All answers must be stated in the form of a question
Medical Jeopardy Category – “Annie, Annie..are you okay?” (New ACLS Guidelines) ---Circulation, August 22, 2000, Vol. 102 (suppl 1)
Value
100
The “ANSWER”
The presence of family members at a
resuscitation scene has this type of
recommendation.
The CORRECT QUESTION
What is a Class IIb positive
recommendation?
200
The new guidelines suggest that the term
“DNR” be changed to this.
There are three known cardiac arrest
variables that predict outcome of
resuscitation. These are two of them.
What is “DNAR” (Do Not Attempt
Resuscitation)?
What are: (1) witnessed arrest, (2)
initial rhythm and (3) “system
variables” (i.e. time to CPR,
defibrillation and ACLS)?
What is 10-20 minutes?
300
400
Vasopressin is a newly recommended agent
in the ACLS protocol. It is an antidiuretic
hormone that becomes a powerful
vasoconstrictor at higher concentrations.
This is the half-life of vasopressin.
500 (DAILY
DOUBLE)
These are the four anti-arrhythmics (Class
Indeterminant or IIb acceptable) in
medication sequence and their initial
dosages in shock-refractory VF/VT.
What are
1) Amiodarone 300mg IV
push
2) Lidocaine 1.0-1.5 mg/kg IV
push
3) Magnesium sulfate 1-2gm
IV (in torsade de pointes or
hypomagnesemic states)
4) Procainamide 30mg/min in
refractory VF (maximum
dose 17mg/kg)
COMMENTS
Note that family presence at resuscitative efforts
is not a spur-of-the-moment offer, extended or
not extended at the whim of supervising
physicians. Rather, family presence at
resuscitative efforts requires a formal program,
with advance planning, assigned roles, and even
rehearsals.
“Ethical Aspects of CPR and ECC” article
“Patient variables” that predict outcome include
comorbid illness and medications. (“Ethical
Aspects of CPR and ECC” article)
Vasopressin is a Class IIb positive
recommendation. It possesses the positive
effects of epinephrine without the adverse
effects. It does not cause skeletal muscle
vasodilatation or increased myocardial oxygen
consumption since it has no β-adrenergic
activity.
The new guidelines relegate adrenergic agents,
antiarrhythmic agents and buffer therapy to
secondary roles in VF and non-VF patients.
Credible evidence to confirm benefits due to
these agents do not exist. it was not until the
1990s that researchers discovered the dismal
truth that antiarrhythmic drugs were acting more
like proarrhythmic agents.
Medical Jeopardy “Doctor’s Dilemma”
2001 ACP-ASIM Indiana Associates Scientific Meeting
All answers must be stated in the form of a question
Medical Jeopardy Category – “It did what?!!” (Medication Side Effects)
Value
100
The “ANSWER”
This antiepileptic is known for gingival
hyperplasia.
The CORRECT QUESTION
What is phenytoin?
COMMENTS
Likely due to the synergistic
overexpression of c-Myc and bcl-2
oncoprotein induced by phenytoin.
May also be induced by cyclosporin A
and nifedipine
200
300
400
500
This antibiotic class is known for
photosensitivity and permanently discoloring
teeth when taken by children < 8 yo..
The nurse pages you about a patient who has
become erythematous since she started the
infusion of this antibiotic. The patient’s vitals
are stable. You tell her to give the patient some
benadryl and slow down the rate of infusion
because it is not an allergic reaction.
You are doing missionary work overseas and
have only a limited repertoire of antibiotics at
your disposal. You decide to do treat a clear
case of bacterial meningitis with
chloramphenicol. You must keep this in mind
this potential but important adverse event.
Metformin is an oral antihyperglycemic agent
that belongs to the biguanide class of
medications. Metformin is reported to cause
lactic acidosis at a rate of 0.1 case per 1000
patient years. This predecessor medication was
withdrawn due to a high incidence of lactic
acidosis.
What is tetracycline?
What is vancomycin? (red-man
syndrome)
What is aplastic anemia?
What is phenformin?
This is a histamine-mediated event.
Although it can be associated in rare
instances with hypotension, patients
should not be labeled with a vancomycin
allergy. Slowing the rate of infusion or
treatment with H1 receptor blockers is
usually sufficient.
The incidence is 1 in 30,000. When the
bone marrow aplasia is pancytopenic,
the fatality rate is high. In those who
recover, there is a higher rate of acute
leukemia.
Goodman and Gilman’s “The
Pharmacological Basis of Therapeutics”
Medical Jeopardy “Doctor’s Dilemma”
2001 ACP-ASIM Indiana Associates Scientific Meeting
All answers must be stated in the form of a question
Medical Jeopardy Category – “See one, Hear one, Touch one” (Physical Exam)
Value
100
200
300
400
500
The “ANSWER”
This part of the breast tissue extends from the
upper, outer quadrant into the axilla.
When you are manually checking a patient’s
blood pressure, you are listening for these.
The Achilles reflex tests these nerve roots.
These glands lie in the cleft between the labia
minora and the vaginal orifice.
The CORRECT QUESTION
What is the Tail of Spence?
This landmark is defined by the costal margin
inferiorly, the sixth rib superiorly and the left
midaxillary line laterally.
What is Traube’s Triangle or Traube’s
Semilunar Space?
COMMENTS
What are Korotkoff sounds?
What are S1 and S2?
What are Bartholin Glands (or greater
vestibular glands)?
Skene’s glands (or periurethral glands)
lie on either side of and posterior to the
urethra.
Dullness to percussion over this
landmark is suggestive of splenomegaly.
(Harrison’s, 14th Ed.)
Medical Jeopardy “Doctor’s Dilemma”
2001 ACP-ASIM Indiana Associates Scientific Meeting
All answers must be stated in the form of a question
Medical Jeopardy Category – “Who’s Who” (Physicians to Know)
Value
100
200
300
400
500
The “ANSWER”
An English physician who discovered the
vaccination for smallpox.
An English physician who discovered the true
nature of the circulation of blood and the
function of the heart as a pump.
A Canadian physician who became a professor
at Johns Hopkins and had a key role in
transforming the organization and curriculum
of medical education in the U.S.
This American physician was responsible for
organizing the concept of the blood bank.
This Arabic physician was the first to explain
the contagious nature of tuberculosis. His
famous medical work, al-Qunun (“Canon of
Medicine”), helped form the foundation on
which Medieval Europe built its medical
sciences.
The CORRECT QUESTION
Who is Edward Jenner?
COMMENTS
1749-1823
Who is William Harvey?
1578-1657
Who is Sir William Osler?
1849-1919
Who is Charles Drew?
1904-1950
Who is Ibn Sina? (or Avicenna)
980-1037
Medical Jeopardy “Doctor’s Dilemma”
2001 ACP-ASIM Indiana Associates Scientific Meeting
All answers must be stated in the form of a question
Medical Double Jeopardy Category – “Matters of the Heart” (Cardiovascular System)
Value
200
The “ANSWER”
This agent is the cause of most cases of viral
myocarditis.
The CORRECT QUESTION
What is Coxsackie virus B?
COMMENTS
400
With a Swan Ganz catheter, this is the reason
why the pulmonary artery diastolic pressure
approximates the pulmonary capillary wedge
pressure (i.e. left atrial pressure).
The upper limit of the normal Q-T interval.
What is low pulmonary circulation
resistance?
Braunwald, 5th Ed, pg 189, vol 1
600
800
This is what the first 3 positions of the
NASPE/BPEG Generic Pacemaker Code stand
for.
1000
In Ashman phenomenon, the onset of aberrant
complexes is preceded by a relatively longer RR interval. The rate of the aberrant complexes
is usually 300 per minute. This is the reason
why the aberrant complexes usually have a
right bundle branch block (RBBB) pattern.
What is QTc 0.44 sec? (corrected for
heart rate).
Position I = Chamber(s) paced
Position II = Chamber(s) sensed
Position III = Response to sensing
Why is the refractory period of the
right bundle branch is normally longer
than that of the left bundle branch?
NASPE = North American Society of
Pacing and Electrophysiology, BPEG =
British Pacing and Electrophysiology
Group
From page 182, “Electrocardiography of
Clinical Arrhythmias” by Charles Fisch
and Suzanne Knoebel.
Medical Jeopardy “Doctor’s Dilemma”
2001 ACP-ASIM Indiana Associates Scientific Meeting
All answers must be stated in the form of a question
Medical Double Jeopardy Category – “1 + 1 = 2” (Mathematical Equations)
*** Teams should submit answers in writing ***
Value
200
The “ANSWER”
Formula used to calculate the creatinine
clearance.
The CORRECT QUESTION
What is
COMMENTS
(For women, multiply the result by 0.85)
(140 – age) x wt in kg
72 x serum creatinine
400
Formula used to calculate the fractional
excretion of sodium.
What is
[Urine sodium] x [Plasma creatinine]
[Urine creatinine] x [Plasma sodium]
600
Formula used to calculate the free water deficit.
Or (0.6 x wt) x ((Na – 140)/140)
What is
(0.6 x wt in kg) x ((Na/140) – 1)
800
Formula used to correct the measured calcium
level for the patient’s albumin.
What is
measured calcium + 0.8 (4 – albumin)
1000
Formula used to correct the phenytoin level for
the patient’s albumin.
What is
(Phenytoin level)
((0.1 x albumin) + 0.01)
Medical Jeopardy “Doctor’s Dilemma”
2001 ACP-ASIM Indiana Associates Scientific Meeting
All answers must be stated in the form of a question
Medical Double Jeopardy Category – “The little things in life!” (ID)
Value
200
The “ANSWER”
This the “d” in “Td”.
The CORRECT QUESTION
What is diphtheria? (Corynebacterium
diphtheriae)
400
An acutely infectious inflammatory colitis
which is associated with dysentery although
most patients in the industrialized world only
have a mild watery diarrhea. Indianapolis had a
small epidemic of this 2 years ago.
What is shigellosis?
600
The spores of this gram-positive bacilli with a
polypeptide capsule can be used a biological
weapon. When the spores are inhaled and
germinate, they cause hemorrhagic necrosis
and edema of the mediastinum.
What is anthrax or Bacillus anthracis?
800 (DAILY
DOUBLE)
This toxin is one of the most deadly in the
world and causes a descending paralysis
starting with the cranial nerves and progressing
caudally. Be careful of what you eat!
What is botulism?
1000
These two viruses are the only current
members of the Filoviridae family. When they
infect humans, they cause an acute systemic
illness which includes headache, myalgias,
pharyngitis, rash and hemorrhagic
manifestations. The viruses are zoonotic, but
their natural reservoirs have not been
discovered.
What are the Marburg and Ebola
viruses?
COMMENTS
Respiratory anthrax has a biphasic
clinical pattern. The initial 1-3 days
consists of malaise, low-grade fever and
cough. The second phase is sudden and
consists of high fever, tachypnea,
tachycardia, and shock. Survival is rare.
Medical Jeopardy “Doctor’s Dilemma”
2001 ACP-ASIM Indiana Associates Scientific Meeting
All answers must be stated in the form of a question
Medical Double Jeopardy Category – “That is what they tell me” (Practice Guidelines)
Value
200
The “ANSWER”
This type of antibiotic should be initiated
in patients with severe exacerbations of
chronic obstructive pulmonary disease (in
a patient with no findings on the admission
chest x-ray).
The CORRECT QUESTION
What are narrow-spectrum
antibiotics (such as amoxicillin,
bactrim and tetracycline) as
reasonable first-line agents?
400
Prostate screening should be considered in
men older than 50 and with a life
expectancy of this many years.
What is a life expectancy of at least
10 years?
600
The type of antibiotics that should be
administered to a patient with purulent
discharge from the nares or throat.
What is no antibiotic treatment is
required?
800
Intravenous nitroglycerin should be
What is 24 to 48 hours?
administered to pts with an acute MI and
CHF, a large anterior infarction, persistent
ischemia or hypertension for this long.
These are the criteria for which cervical
1. Older than 65 years old
cancer screenings can be stopped in
2. Two satisfactory smears
women who have been regularly screened. 3. No abnormal smears in the
previous 9 years
1000
COMMENTS
No randomized, placebo-controlled trials have
demonstrated the superiority of the newer, broadspectrum antibiotics in acute exacerbations of
COPD. There are randomized, placebo-controlled
trials supporting the use of the amoxicillin,
bactrim and tetracycline.
[ACP-ASIM and the American College of Chest
Physicians (Apr 2001)]
United States Preventive Services Task Force
(1996), American College of Preventive Medicine
(1998), and American Urological Association
(1999)
Antibiotics should not be used to treat nonspecific
upper respiratory tract infections in previously
healthy adults. Purulent secretions from the nares
or throat do not predict bacterial infection or
benefit from antibiotic treatment. Antibiotic
treatment of adults with non-specific upper
respiratory tract infections does not enhance
illness resolution or prevent complications.
[ACP-ASIM (March 2001)]
American College of Cardiology/American Heart
Association (1999)
For women who have never been previously
screened, Pap smears can be stopped after age 65
and if there have been three normal annual smears.
[American College of Preventive Medicine
(1996)]
Medical Jeopardy “Doctor’s Dilemma”
2001 ACP-ASIM Indiana Associates Scientific Meeting
All answers must be stated in the form of a question
Medical Double Jeopardy Category – “Is this bean dip?” (Nephrology)
Value
200
The “ANSWER”
The 4 primary types of kidney stones.
The CORRECT QUESTION
What are struvite, uric acid, calcium
and cystine stones?
400
This type of glomerulopathy is seen with
hepatitis B and C.
What is membranous glomerulopathy?
600
A 30 year-old patient presents with painless
gross hematuria 2 days after receiving a flu
shot. He reports a similar episode 2 months ago
after he had a sore throat. This is the most
likely diagnosis.
What is IgA nephropathy or Berger’s
Disease?
800 (DAILY
DOUBLE)
Three classes of antihypertensives can be used
to reduce proteinuria in proteinuric patients.
1000
Aluminum hydroxide can be used as a
phosphate binder; however, its use has declined
significantly because aluminum can cause
osteomalacia through this mechanism.
What are (1) angiotension converting
enzyme (ACE) inhibitors, (2)
angiotensin II receptor blockers, and
(3) non-dihydropyridine calcium
channel blockers (e.g. verapamil and
diltiazem)?
What is depression of PTH
biosynthesis?
COMMENTS
Brenner and Rector’s “The Kidney”, 6th
Ed.
Medical Jeopardy “Doctor’s Dilemma”
2001 ACP-ASIM Indiana Associates Scientific Meeting
All answers must be stated in the form of a question
Medical Final Jeopardy Category – “Bugs” (ID)
Value
Variable
The “ANSWER”
This alphavirus is distributed primarily in the
Americas. Infections are usually heralded by
headaches, high fevers, polyarthritis, and rash.
In cases in which there is CNS involvement,
these initial symptoms are followed by mental
confusion and somnolence and may progress to
coma. The last epidemic was documented in
1941 in the western US and Canada and
involved 3400 cases. The vector is Culex
tarsalis, a mosquito.
The CORRECT QUESTION
What is the Western Equine
Encephalitis virus?
COMMENTS
Three alphaviruses cause human disease
in the United States: Eastern Equine
Encephalitis virus, Western Equine
Encephalitis virus, and Venezuelan
Equine Encephalitis virus. As the name
implies, all three viruses were initially
isolated from the brains of horses. The
incidence of alphavirus encephalitis has
been declining the last 12 years. Since
1994, there have been no reported cases
of Western Equine Encephalitis.
This virus is considered to be a potential
agent for bioterrorism.