Cardiology
A patient with HFrEF (EF 30%) is on a loop diuretic only. These are the four drug classes that reduce mortality.
What are ARNI/ACEi/ARB, evidence-based beta blockers (metoprolol succinate, carvedilol, bisoprolol), MRAs, and SGLT2 inhibitors?
A COPD patient has a resting SpO₂ of 87% on room air. This is the treatment, and it is one of only two interventions that improve survival in COPD.
What is long-term home oxygen therapy (indicated for PaO₂ ≤55 or SpO₂ ≤88%)? The other is smoking cessation.
A cirrhotic patient presents with hematemesis from suspected variceal bleeding. These are the three key initial interventions besides resuscitation.
What are IV octreotide, IV ceftriaxone (antibiotic prophylaxis), and urgent EGD with band ligation?
A type 2 diabetic with heart failure and CKD needs a second agent. This class is preferred, and these are two adverse effects.
What are SGLT2 inhibitors, with genital mycotic infections and euglycemic DKA (also volume depletion and Fournier gangrene)?
A 62-year-old has fever, neck stiffness, and altered mental status. This is the empiric regimen, and this drug is added for age over 50.
What are vancomycin, ceftriaxone, and dexamethasone, with ampicillin added for Listeria? Give steroids before or with the first antibiotic dose. Get a CT before LP only if there are focal deficits, papilledema, or immunocompromise.
A young athlete collapses during practice. He has a systolic murmur that gets louder with Valsalva and softer with squatting. This is the diagnosis, and this class of drug worsens it.
What are hypertrophic cardiomyopathy and vasodilators/diuretics (anything that reduces preload or afterload)? Treat with a beta blocker, and consider an ICD if he is high risk for sudden death.
A patient with a recent leg DVT becomes acutely dyspneic and hypotensive (BP 80/50), and echo shows RV strain. This is the management.
What is systemic thrombolysis (alteplase)? This is a massive (high-risk) PE. Use catheter-directed therapy or embolectomy if thrombolysis is contraindicated.
A patient with acute hepatitis has HBsAg negative, anti-HBs negative, and anti-HBc IgM positive. This is the interpretation.
What is the window period of acute hepatitis B? HBsAg has cleared, and anti-HBs has not yet appeared.
A woman with heat intolerance, exophthalmos, and pretibial myxedema has this radioactive iodine uptake pattern. She becomes pregnant in the first trimester, and this is the preferred drug.
What are diffusely increased uptake (Graves disease) and propylthiouracil? Methimazole is teratogenic in the first trimester, and PTU is switched to methimazole afterward.
A 72-year-old woman has new headache, jaw claudication, and an ESR of 95. This is the next step, and this is the feared complication.
What are high-dose glucocorticoids immediately (before temporal artery biopsy) and irreversible vision loss? This is giant cell arteritis, associated with polymyalgia rheumatica.
Five days after an anterior MI, a patient develops a harsh holosystolic murmur at the left sternal border. Right heart catheterization shows this finding, and this artery is involved.
What are a step-up in oxygen saturation from the right atrium to the right ventricle, and the LAD (septal branches)? This is a ventricular septal rupture.
A 65-year-old smoker has a central, cavitating lung mass and hypercalcemia with a low PTH. This is the histology, and this is the cause of the hypercalcemia.
What are squamous cell carcinoma and PTHrP secretion?
A 24-year-old has bloody diarrhea from continuous rectal-to-colonic inflammation and is p-ANCA positive. This associated hepatobiliary disease is a risk, and this is the imaging finding.
What are primary sclerosing cholangitis and "beading" of bile ducts on MRCP/ERCP? This is ulcerative colitis. PSC also raises the risk of cholangiocarcinoma.
A patient on chronic prednisone stops it abruptly and presents with hypotension, hyponatremia, and hypoglycemia. Potassium is normal. This is the reason potassium is normal, and this is the treatment.
What are preserved aldosterone (the RAAS is intact in secondary adrenal insufficiency) and IV hydrocortisone with normal saline?
A patient has fever, thrombocytopenia, microangiopathic hemolytic anemia, renal dysfunction, and neurologic changes. This is the deficient enzyme, and this is the treatment.
What are ADAMTS13 and plasma exchange? This is TTP. Platelet transfusion is generally avoided.
Four days after an inferior MI, a patient develops a new apical holosystolic murmur and flash pulmonary edema. This structure is vulnerable because it receives a single blood supply from this artery.
What is the posteromedial papillary muscle, supplied by the posterior descending artery (PDA)? This is papillary muscle rupture causing acute mitral regurgitation.
A 68-year-old man has progressive dry cough, bibasilar "Velcro" crackles, and clubbing. HRCT shows subpleural honeycombing. PFTs show this pattern, and these drugs slow disease progression.
What are a restrictive pattern with reduced DLCO, and pirfenidone or nintedanib? This is idiopathic pulmonary fibrosis.
A patient has fever, jaundice, RUQ pain, hypotension, and confusion. This is the diagnosis and the definitive management.
What are ascending cholangitis (Reynolds pentad) and IV antibiotics plus urgent biliary decompression (ERCP)?
A patient develops AKI 10 days after starting a new antibiotic, with fever, rash, eosinophilia, and WBC casts. This is the diagnosis and the first step in management
What are acute interstitial nephritis and stopping the offending drug (steroids if there is no improvement)? Common causes are beta-lactams, PPIs, and NSAIDs.
A postoperative patient on heparin has a platelet drop from 250 to 90 on day 7 and develops a new DVT. This is the diagnosis and the management.
What are heparin-induced thrombocytopenia and stopping all heparin plus starting a non-heparin anticoagulant (argatroban or bivalirudin)? Avoid warfarin until platelets recover, and use the 4T score to guide testing.
A patient with WPW syndrome has an irregular, wide-complex tachycardia at 200 bpm and is hemodynamically stable. This drug is used, and this class of drugs must be avoided.
What are procainamide (or ibutilide), and AV nodal blockers (adenosine, beta blockers, calcium channel blockers, digoxin)? This is pre-excited atrial fibrillation. Blocking the AV node pushes conduction down the accessory pathway and can cause VF. Cardiovert if unstable.
A patient with long-standing asthma has worsening wheezing, expectoration of brown mucus plugs, peripheral eosinophilia, and a markedly elevated total IgE. CT shows central bronchiectasis. What is the diagnosis?
What is allergic bronchopulmonary aspergillosis (ABPA)?
A 25-year-old has elevated transaminases, a Coombs-negative hemolytic anemia, and a low alkaline phosphatase. Slit-lamp exam shows Kayser-Fleischer rings. This is the diagnosis and the defective gene.
What are Wilson disease and the ATP7B gene (chromosome 13, impaired biliary copper excretion)?
A 50-year-old has nephrotic-range proteinuria, edema, and hyperlipidemia. Biopsy shows diffuse capillary wall thickening, "spike and dome" on silver stain, and subepithelial deposits on electron microscopy. This is the diagnosis and the associated autoantibody.
What is membranous nephropathy and anti-PLA2R antibodies?
A 38-year-old man with HIV, off antiretrovirals for a year, has headache, fever, and new right-sided weakness. His CD4 count is 40/µL and Toxoplasma IgG is positive. MRI shows multiple ring-enhancing lesions in the basal ganglia. This is the empiric treatment, and this is the diagnosis to consider if he does not improve after 2 weeks.
What are pyrimethamine plus sulfadiazine plus leucovorin (to prevent marrow suppression), and primary CNS lymphoma (get a brain biopsy)?