Board Certified-ish
A hospitalized patient develops hyponatremia. Urine osmolality is >100 mOsm/kg and urine sodium is elevated. What diagnosis should you consider?
SIADH
A 57-year-old has a 25-pack-year smoking history and currently smokes. What screening test should be offered annually?
Low-dose CT of the chest
-Annual LDCT is recommended for adults 50–80 years old with ≥20 pack-years who currently smoke or quit within the past 15 years.
This gold-standard scoring system, the Child-Pugh, and this newer MELD score are both used to assess severity of failure of this organ
cirrhosis / chronic liver failure
A 76-year-old patient has never received an RSV vaccine. How many doses of RSV vaccine should this patient receive?
For adults ≥75, one dose of an RSV vaccine is recommended; additional doses are not currently recommended.
This common medication can cause orange-red discoloration of urine, sweat, saliva, and tears, sometimes alarming patients who don't know to expect it.
Rifampin
A patient has hypercalcemia, an elevated PTH, and low serum phosphate. What is the most likely diagnosis?
primary hyperparathyroidism
A 42-year-old woman at average risk asks when she should begin routine mammography. According to current USPSTF recommendations, what should you tell her?
screening mammography every other year from age 40 through 74
Patients with acute diverticulitis who have resolution of all symptoms should undergo which test?
A 29-year-old woman is 30 weeks pregnant and received Tdap during her previous pregnancy. Should she receive Tdap again during this pregnancy?
Yes—Tdap during every pregnancy, preferably at 27–36 weeks
This bacterium, discovered by Marshall and Warren (who won a Nobel Prize partly by self-experimentation), is the leading cause of peptic ulcers.
H. Pylori
A hospitalized patient with atrial fibrillation suddenly develops hypotension, altered mental status, and a heart rate of 180/min. The ECG shows a regular narrow-complex tachycardia. What is the immediate treatment?
synchronized cardioversion
**
A 55-year-old man is evaluated during his annual physical examination. He asks whether he should be screened for prostate cancer. He has not had nocturia, urinary frequency or hesitancy, or any change in urine stream. His 80-year-old father has benign prostatic hypertrophy. The patient is unaware of any family history of prostate cancer.
Physical examination findings, including vital signs, are normal.
A. Discuss benefits and harms of screening.
B.Order prostate-specific antigen testing
C.Perform digital rectal examination.
D.Refer for transrectal prostate ultrasound.
E.No screening is needed
Discuss benefits and harms of screening
Current recommendations by the American Cancer Society, American College of Physicians, American Urological Association, and U.S. Preventive Services Task Force (USPSTF) advocate for shared decision making and screening with prostate-specific antigen (PSA) blood testing for patients who request screening after an informed discussion
The two most frequent skin lesions associated with IBD include?
1. Erythema nodosum
2. Pyoderma gangrenosum
A healthy 45-year-old adult has never received hepatitis B vaccination. Which of the following is true regarding HepB vaccination?
HepB vaccination is routinely recommended for all adults age 19–59
**Which drug was originally derived from Brazilian Pit Vipers?
ACE Inhibitors
A patient with untreated HIV has a CD4 count of 85 cells/mm³ and develops progressive dyspnea, nonproductive cough, and hypoxemia. CT chest demonstrates diffuse bilateral ground-glass opacities. What is the most likely diagnosis? and of hypoxic, what tx should be started?
1. Pneumocystis jirovecii pneumonia (PJP)
2. corticosteroids
A 68-year-old woman had a total hysterectomy with removal of the cervix for benign fibroids. She has no history of CIN2+, cervical cancer, or immunocompromise. Does she still need routine cervical cancer screening?
No
-Cervical cancer screening is not recommended after total hysterectomy with cervix removal when there is no history of high-grade precancer or cervical cancer.
**A patient with decompensated cirrhosis is being evaluated for liver transplantation. Which four laboratory variables are used in the MELD-Na score?
Bilirubin, INR, creatinine, and serum sodium
A 58-year-old woman with alcohol use disorder received PCV13 at age 56 and PPSV23 at age 57. She asks whether she needs another pneumococcal vaccine today. What is the recommended next step?
One dose of PCV20 or PCV21, given at least 5 years after the most recent pneumococcal vaccine
-For adults ≥50 who have never received a pneumococcal vaccine, PCV15, PCV20, or PCV21 can be given.
-If PCV15 is used, PPSV23 is given ≥1 year later (minimum 8 weeks in certain high-risk situations)
-For adults who previously received PCV13 + PPSV23, CDC recommends PCV20 or PCV21 ≥5 years after the last pneumococcal vaccine based on shared clinical decision-making
Name of the oral Alpha blocker given in pheochromocytoma to control BP
Phenoxybenzamine
A patient with potassium of 6.8 mEq/L has peaked T waves and QRS widening. Which treatment should be given first to stabilize the cardiac membrane?
**Followed by what interventions?
1. IV Ca
____________
2. IV insulin (regular 10 units) with dextrose (25 g / 50 mL of D50)
Nebulized albuterol (10–20 mg), which is synergistic with insulin. [3-4][6]
Then address potassium elimination — loop diuretics if volume-tolerant, potassium binders (sodium zirconium cyclosilicate or patiromer), and hemodialysis as the definitive option, particularly in renal failure or refractory cases.
**A 62-year-old man had a screening colonoscopy 3 years ago that found two tubular adenomas, each 8 mm, which were completely removed. He has no family history of colorectal cancer and no new symptoms. When should his next colonoscopy be performed?
**Bonus question**
Instead, suppose that the same patient's prior colonoscopy had found three tubular adenomas, each 8 mm, all completely removed. How does this change the recommended surveillance interval?
1. 7–10 years after the previous colonoscopy
_____________________________
2. 3-5ys
_____________________________
A 74-year-old woman with atrial fibrillation (on no anticoagulation due to prior falls), coronary disease, and hypertension presents with the sudden onset of severe, diffuse abdominal pain 3 hours ago. She has vomited twice and had one loose bowel movement. On exam she is in obvious distress, HR 118 and irregularly irregular, BP 148/90; the abdomen is soft with only mild diffuse tenderness and no rebound or guarding. Labs show WBC 19,000, lactate 4.2 mmol/L, and metabolic acidosis. CT angiography shows a filling defect in the proximal superior mesenteric artery with no pneumatosis or free air.
Which of the following is the most appropriate next step in management?
A. Oral vancomycin and metronidazole
B. Urgent colonoscopy
C. Systemic anticoagulation with heparin, IV fluids, broad-spectrum antibiotics, and urgent revascularization
D. High-dose IV proton pump inhibitor and urgent EGD
E. Observation with serial abdominal exams and repeat lactate
C). Systemic anticoagulation with heparin, IV fluids, broad-spectrum antibiotics, and urgent revascularization
This is acute mesenteric ischemia from an SMA embolus
A 32-year-old patient with HIV has a CD4 count of 450 cells/mm³ and no history of shingles vaccination. Which vaccine should be given to prevent herpes zoster?
Recombinant zoster vaccine (Shingrix), 2 doses
-> immunocompromising conditions, including HIV regardless of CD4 count, are an indication for the 2-dose RZV series starting at age ≥19.
This unusual phenomenon can cause a patient's urine to turn purple, particularly in patients with long-term urinary catheters and certain bacterial infections.
Purple urine bag syndrome?
-Certain bacteria metabolize tryptophan → indole → indican → pigments that produce the purple discoloration.