Breathless Updates
On my nerves
heart of darkness
Gut Feelings
Bugs and Drugs
Gumbo
100
Under the 2026 PE guidelines, which category represents an asymptomatic patient who can be safely discharged from the ER without hospitalization?
Category A
100
What condition is caused by immune-mediated instability of post-synaptic ACh receptor or MuSK?
Myasthenia Gravis
100
Aortic stenosis murmur
harsh crescendo-decrescendo systolic murmur radiating to the carotids
100
What is the most common cause of chronic non-infectious liver disease in the United States?
Metabolic dysfunction-associated steatotic liver disease (MASLD).
100
While malaria parasites infect both the liver and red blood cells, which stage is directly responsible for causing clinical disease symptoms?
The red blood cell (erythrocytic) stage
100
Beck's triad
hypotension, jugular venous distension, and muffled heart sounds
200
The 2026 guidelines recommend against using what specific anatomic feature to define early risk stratification in categories A–C?
Thrombus burden (clot size/anatomy).
200
A 68-year-old man with small cell lung cancer presents with proximal leg weakness that improves after a few seconds of voluntary contraction. What is the most likely diagnosis?
Lambert-Eaton Myasthenic Syndrome (LEMS).
200
A 14-year-old boy drowns. He is resuscitated and his baseline ECG shows a QTc interval of 520 ms. Genetic testing is most likely to reveal a defect in a channel affecting which specific ion, causing Long QT Syndrome Type 1?
Potassium (the slow delayed rectifier potassium channel, IKs). KCNQ1 gene, AD pattern
if the QT interval fails to appropriately shorten when heart rate increases during exercise, VF/VT can occur.
This explains why patients with long QT syndrome type 1 are particularly vulnerable to cardiac events during physical exertion.
200
What biologic drug class is the first-line therapy to induce fistula closure in fistulizing Crohn's disease?
Anti-TNF agents (specifically Infliximab, which has the strongest data for fistulizing disease).
200
What common analgesics are contraindicated in this mosquito-borne viral disease that presents with sudden high fever, severe retro-orbital pain, and a "breakbone" rash?
NSAIDs are contraindicated in Dengue fever due to increased risk of (GI) bleeding
200
What pruritic, vesicular dermatologic finding on extensor surfaces is highly associated with Celiac disease?
Dermatitis herpetiformis.
300
For a patient with a first acute PE without a major reversible risk factor, how long should anticoagulation be continued?
Into the extended phase (indefinitely, beyond the initial 3–6 months)
300
Anti-Jo1 antibodies and interstitial lung disease are hallmark features of which immune-mediated myopathy?
Anti-synthetase syndrome
(Anti-Jo1 = anti-histidyl-tRNA synthetase).
anti-PL-7 (anti-threonyl-tRNA synthetase) and anti-PL-12 (anti-alanyl-tRNA synthetase)
300
What is the only therapy shown to decrease mortality in this symptomatic condition?
ICD or external cardiac defibrillator
coved ST-segment elevation ≥2 mm in at least one right precordial lead (V1-V3), followed by a negative T-wave.
A Type 2 "saddle-back" pattern (convex ST-segment elevation ≥0.5 mm with positive T-wave) is suggestive but not diagnostic of Brugada syndrome.
300
Serum Ascites Albumin Gradient (SAAG) and asctiic total protein suggestive of portal hypertension due to cirrhosis.
SAAG >= 1.1 g/dL
ascitic total protein < 2.5 g/dL
300
What is the empiric antibiotic regimen for bacterial meningitis in adults over 50 years old?
Ceftriaxone, Vancomycin, and Ampicillin
300
Name at least one of two species of Plasmodium known for having dormant liver forms that can cause a relapse of malaria months after the initial infection?
Plasmodium vivax and P. ovale
400
What is the preferred initial parenteral anticoagulant therapy for acute PE according to the 2026 guidelines?
Low-molecular-weight heparin (LMWH) over unfractionated heparin (UFH)
400
In patients with Myasthenia Gravis, which chest imaging is indicated for all AChR antibody-positive patients to assess for a specific mass?
CT of the chest (to assess for a thymoma)
400
What specific physical exam maneuver will increase the intensity of the murmur in Hypertrophic Obstructive Cardiomyopathy (HOCM) but decrease the intensity of an aortic stenosis murmur?
The Valsalva maneuver (or standing from a squat).
(decrease preload)
maneuvers that increase preload (such as squatting or passive leg raises) or afterload (handgrip) will decrease the HOCM murmur while increasing the aortic stenosis murmur.
400
What autoantibody is the diagnostic hallmark of Primary Biliary Cholangitis (PBC)?
Anti-mitochondrial antibody (AMA).
400
In Southeast Asia, where quinolone resistance is high, what is the recommended single 1-gram dose of an antibiotic for traveler's diarrhea?
Azithromycin
400
This physical exam finding, which appears on an MRI as increased T1 signal indicating fatty infiltration in the genioglossus muscle, can be seen in MuSK-positive Myasthenia Gravis and ALS
Triple furrowed tongue (or Bright tongue sign)
An atrophic tongue with one midline and two parallel longitudinal grooves.
500
What inhaled therapy received a Class 2b recommendation to reduce right ventricular afterload in acute PE categories C2 through E?
Inhaled pulmonary vasodilators (inhaled nitric oxide). NOT systemic vasodilators!
500
A patient presenting with a very high CK level and proximal weakness over weeks to months who tests positive for the anti-SRP antibody most likely has what specific class of myopathy?
Immune-Mediated Necrotizing Myopathy
IMNMs: Anti-HMGCR myopathy is strongly associated with statin exposure, whereas anti-SRP myopathy is not.
biopsy only necessary to diagnose seronegative dz (1/3 of cases)
500
A 16-year-old collapses while running a track race. Her resting ECG and echocardiogram are completely normal. An exercise stress test induces bidirectional and polymorphic ventricular tachycardia. What is the most likely diagnosis?
Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)
500
What is the screening interval for colon cancer in a patient with a first-degree relative diagnosed with colon cancer at age 50?
Every 5 years, starting at age 40
500
What is the preferred, short-course treatment for latent tuberculosis in an otherwise healthy adult?
Isoniazid and Rifapentine weekly for 3 months
or
daily Rifampin for 4 months
500
Before prescribing azathioprine (Imuran) for Myasthenia Gravis, testing for a genetic mutation in this specific enzyme is recommended to avoid life-threatening bone marrow toxicity.
Thiopurine methyltransferase (TPMT)