🎇 Final Jeopardy 2026 🎇

Lipid Lowdown 🧈

100

The 2026 ACC/AHA guideline replaces the Pooled Cohort Equations with what newer risk calculator?

The AHA PREVENT-ASCVD equations for 10- and 30-year primary prevention risk assessment in adults aged 30–79

200

Per 2026 ACC/AHA, what is the LDL-C goal for a patient with clinical ASCVD at very high risk?

<55 mg/dL

300

In the 2026 guideline, CAC score ≥1000 AU triggers what LDL-C target, and CAC = 0 in a borderline-risk patient justifies what management decision?

CAC ≥1000 → LDL-C goal <55 mg/dL

CAC = 0 → reasonable to defer pharmacotherapy and optimize lifestyle (unless LDL ≥190 or diabetes)

400

Per 2026 ACC/AHA, Lipid Lowering Therapy is recommended for primary prevention regardless of LDL-C level in adults aged 40–75 with which THREE conditions? 

1. CKD stage 3 or higher

2. diabetes (type 1 or 2)

3. HIV infection

500

The VESALIUS-CV trial results arrived after the 2026 guideline was finalized. What were its findings and how do the guideline authors say it should reshape future updates?

ESALIUS-CV showed significant CV benefit of intensive LDL-C lowering to <55 mg/dL in patients WITHOUT prior MI or stroke - authors call for a single <55 mg/dL pathway for all ASCVD patients in future revisions

Failing Gracefully 🍃

100

What EF threshold and QRS duration qualify a patient for CRT?

EF ≤35%, QRS ≥150ms with LBBB morphology (Class I)

p.s. ≥130ms LBBB or ≥150ms non-LBBB (Class IIa)

200

PARADIGM-HF: what was sacubitril/valsartan compared to? 

bonus: what was the mortality reduction

Compared to enalapril

bonus: 20% relative risk reduction in CV death and HF hospitalization

300

Name the five SCAI shock stages and what ONE hemodynamic threshold that defines Stage C ("Classic") shock.

A (At risk), B (Beginning), C (Classic), D (Deteriorating), E (Extremis); Stage C: MAP <60, CI <2.2 L/min/m², lactate >2 mmol/L despite initial resuscitation

400

What is the Cardiac Power Output formula and what number predicts mortality?

CPO (W) = MAP × CO / 451 — CPO <0.6W predicts mortality

500

What defines diuretic resistance and name three strategies to overcome it?

Inadequate diuresis despite furosemide ≥160mg IV daily

strategies: switch to bumetanide/torsemide (better oral bioavailability), add thiazide for sequential nephron blockade, continuous infusion vs bolus, ultrafiltration if refractory

Plaque Attack 💥

100

Per 2025 ACC/AHA, what is the preferred P2Y12 inhibitor in ACS?

Ticagrelor or prasugrel (Class I, equal)

clopidogrel only if those are contraindicated, not tolerated, unaffordable, or unavailable

200

Intracoronary imaging to guide PCI was upgraded to what class of recommendation in 2025 ACC/AHA, and from what prior class?

Upgraded to Class I

Previously Class IIa in the 2021 revascularization guideline; based on evidence that IVUS/OCT reduces restenosis, recurrent ACS, and improves survival

300

Per 2025 ACC/AHA, when is oral P2Y12 pretreatment before cath recommended?

Only if expected delay to cath >24 hours — routine pretreatment before known cath timing is not recommended due to bleeding risk without proven ischemic benefit

400

Per 2025 ACC/AHA, when is oral P2Y12 pretreatment before cath recommended?

Only if expected delay to cath >24 hours — routine pretreatment before known cath timing is not recommended due to bleeding risk without proven ischemic benefit

500

Name the three pathophysiologic mechanisms of no-reflow after primary PCI.

Distal atheroembolism — particulate debris from plaque disruption occludes microvasculature.

Ischemia-reperfusion injury — mPTP opening, ROS, calcium overload causing microvascular endothelial swelling and cardiomyocyte death.

Microvascular obstruction — endothelial dysfunction, neutrophil/platelet plugging, and interstitial edema compressing capillaries — "spasm" alone is an oversimplification and not widely cited as a primary no-reflow mechanism in most textbooks.

Heart on Fire 🔥

100

How many of the four diagnostic criteria are required for acute pericarditis?

At least 2 of 4 (chest pain, friction rub, ECG changes, new effusion)

200

Minimum symptom-free interval distinguishing recurrent from incessant pericarditis?

≥4 weeks

300

Mechanism of rilonacept? 

Fun Bonus: its RHAPSODY trial result?

IL-1α/β trap; 

Bonus: reduced pericarditis recurrence by 96% vs placebo in randomized withdrawal design

400

When can a competitive athlete return to sport after acute pericarditis per 2025 ESC?

Symptom-free + normal CRP, ECG, echo, Holter, AND normal stress test without exercise-induced arrhythmia — minimum 3 months

500

Name THREE of the FOUR triggers of post-cardiac injury syndrome AND its proposed mechanism per 2025 ESC.

1. MI

2. cardiac surgery

3. ablation

4. pacemaker implant

mechanism: autoimmune reaction to released cardiac antigens (antimyosin antibodies)

Rhythm & Blues 🎵

100

Orthodromic AVRT — which pathway conducts antegrade and which retrograde?

Antegrade via AV node; retrograde via accessory pathway — produces narrow complex tachycardia

200

Epsilon wave — where is it seen and what does it diagnose?

Terminal notch on QRS downslope in V1–V3; pathognomonic for ARVC

300

Negative delta wave in lead I with positive delta in V1 — where is the accessory pathway? 

Left lateral free wall accessory pathway

400

The PR interval on surface ECG has three EGM components — name them and their approximate normal durations.

PA interval (intra-atrial, 20–60ms)
AH interval (AV node, 55–130ms)
HV interval (His-Purkinje, 35–55ms)

= total normal PR 120–200ms

500

Name the five major risk factors for SCD in HCM per ACC/AHA guidelines.

Prior cardiac arrest or sustained VT, family history of HCM-related SCD, unexplained syncope, max LV wall thickness ≥30mm, non-sustained VT on ambulatory monitoring

Texas Sized ⭐️

100

What is the state capital of Texas?

Austin

200

Texas has no state income tax — what is the primary tax that funds state government instead?

Property tax — Texas has some of the highest property tax rates in the nation, averaging ~1.6–1.8% of assessed value

300

Baylor Scott & White Health is the largest not-for-profit health system in Texas — approximately how many hospitals does it operate?

~51 hospitals across Texas

400

Texas has its own power grid independent of the rest of the US — name it and why it became nationally infamous in 2021.

ERCOT (Electric Reliability Council of Texas) — regulated by the Public Utility Commission of Texas, not the federal FERC; became infamous during Winter Storm Uri (February 2021) when the grid nearly collapsed, killing ~246 people and causing $200+ billion in damages due to inadequate weatherization of natural gas infrastructure

500

The Texas Medical Liability Trust is unique nationally — what did Texas Proposition 12 (2003) establish and how did it affect physician recruitment?

Capped non-economic damages in medical malpractice lawsuits at $250,000 — dramatically reduced malpractice insurance premiums; Texas went from physician shortage to net physician gain within 5 years, became a model for tort reform nationally