DeGowin's Diagnostic Examination

Question 1

Rheumatic fever

Answer 1

1-4 weeks after strep pharyngitis
Malaise, fatigue, anorexia, fever
Migratory polyarthritis
Carditis- tachycardia, muffled heart sounds, cardiomegaly, valvular insufficiency, friction rub, gallop
Skin lesions-
Erythema marginatum -Coalescing circular erythematous areas over trunk and extremities- migratory and transitory
Rheumatic nodules- firm, nontender masses over joint prominences, tendon sheaths of limbs, scalp, spine
Sydenham chorea

Question 2

Neuroleptic malignant syndrome

Answer 2

1-2 days after neuroleptic drug

Hyperthermia, rigidity, altered mental status, labile BP, tachycardia, tachypnea, metabolic acidosis

Question 3

Malignant hyperthermia

Answer 3

Inherited disorder sarcoplasmic reticulum produces sustained muscle contraction after anesthetics
Rigidity, hyperthermia, rhabdo, metabolic acidosis

Question 4

Heat stroke

Answer 4

Failure of thermoregulatory system leads to decreased sweating and increased temperature
Think CV disease or meds limit the increased CO needed for skin perfusion
Chronically ill adult during heat wave-
Clue: hot, dry skin

Question 5

Heat exhaustion/prostration

Answer 5

Exertion in hot, humid environment leads to excess fluid and electrolyte loss
Palpitations, lassitude, HA, nausea, vomiting, cramps;
Tachycardia, diminished BP, diaphoreses, ashen, cool moist skin, dilated pupils