USPSTF Has Entered the Chat
Nebs and Prayers
To MRI or Not to MRI
Lub Dub Club
A1c? Never Heard of Her
Evidence-Based Guessing
FINAL JEOPARDY: Low Yield My A**
100
A 67-year-old man with a 30 pack-year smoking history quit smoking 10 years ago. He feels well and asks what cancer screenings he qualifies for. According to USPSTF guidelines, which imaging test should be offered.
What is low-dose CT screening for lung cancer?
100
A 28-year-old woman with moderate persistent asthma reports daytime symptoms multiple times weekly and nighttime awakenings twice monthly. She uses albuterol several times weekly despite low-dose inhaled corticosteroid therapy. According to current GINA guideline recommendations, this is the preferred next step in management.
What is SMART therapy with ICS-formoterol (e.g., Symbicort) as both maintenance and rescue therapy?
100
A 24-year-old man presents with acute lateral ankle pain and swelling after inversion injury while playing basketball. He is able to bear weight immediately after injury and in clinic today. There is tenderness over the anterior talofibular ligament but no bony tenderness over the malleoli. According to the Ottawa ankle rules, this is the most appropriate next step in management.
What is no imaging/conservative management?
100
A 67-year-old woman presents with dyspnea, orthopnea, and bilateral lower extremity edema. Echocardiogram demonstrates an ejection fraction of 30%. According to guideline-directed medical therapy, these medication classes reduce mortality in HFrEF.
What are beta blockers, ACE inhibitors/ARBs/ARNIs, mineralocorticoid receptor antagonists, and SGLT2 inhibitors?
100
A 54-year-old man with type 2 diabetes presents with recurrent severe hypoglycemia despite stopping insulin several months ago. Laboratory evaluation demonstrates elevated insulin levels with suppressed C-peptide levels. This is the most likely cause.
What is exogenous insulin use?
100
A 58-year-old woman presents with temporal headache, jaw claudication, and elevated ESR. According to current recommendations, this treatment should be initiated immediately before confirmatory testing.
What are glucocorticoids?
200
A 42-year-old woman with obesity and hypertension presents for an annual exam. She has no symptoms and asks whether she should begin screening mammography. According to current USPSTF recommendations, screening should begin at this age.
What is age 40?
200
A 58-year-old woman with a 40 pack-year smoking history undergoes spirometry for progressive dyspnea. Pulmonary function testing demonstrates an FEV1/FVC ratio of 0.62 after bronchodilator administration. This finding is diagnostic of this disease process.
What is COPD?
200
A 14-year-old boy with a BMI of 34 kg/m² presents with several weeks of limp and poorly localized left hip pain radiating to the knee. Examination demonstrates decreased internal rotation and obligate external rotation of the hip. This is the most likely diagnosis.
What is slipped capital femoral epiphysis (SCFE)?
200
A 23-year-old woman presents with palpitations that begin and end suddenly. ECG during symptoms demonstrates a narrow-complex tachycardia at 180 bpm without clearly visible P waves. She is hemodynamically stable. Vagal maneuvers are unsuccessful. This is the most appropriate first-line pharmacologic treatment.
What is adenosine?
200
A 34-year-old woman presents with palpitations, tremor, weight loss, and suppressed TSH. Radioactive iodine uptake scan demonstrates diffusely decreased uptake. She recently recovered from an upper respiratory infection and reports anterior neck tenderness. This is the most likely diagnosis.
What is subacute thyroiditis (de Quervain thyroiditis)?
200
A 31-year-old woman presents with recurrent oral ulcers, painful genital ulcers, and episodic uveitis. This is the most likely diagnosis.
What is Behçet disease?
300
A 62-year-old man with hypertension and hyperlipidemia asks if he should start taking aspirin to prevent heart attacks because his friend recently did. He has no history of cardiovascular disease and no increased bleeding risk. According to current USPSTF recommendations, routine initiation of aspirin for primary prevention in adults age 60 or older is given this recommendation.
What is against routine initiation/not recommended?
300
A 72-year-old hospitalized patient develops acute shortness of breath, pleuritic chest pain, and tachycardia 2 days after hip surgery. Oxygen saturation is 88% on room air. Chest x-ray is normal. This is the most appropriate next diagnostic test.
What is CT pulmonary angiography?
300
A 63-year-old woman presents with acute knee pain and swelling. Synovial fluid analysis demonstrates rhomboid-shaped positively birefringent crystals under polarized light microscopy. This is the most likely diagnosis.
What is calcium pyrophosphate deposition disease (pseudogout)?
300
A 56-year-old woman presents with sharp pleuritic chest pain improved by leaning forward following a recent viral illness. ECG is shown below.
What is the first-line treatment?
What are NSAIDs and colchicine?
300
A 37-year-old woman presents with weight gain, proximal muscle weakness, hypertension, easy bruising, and purple abdominal striae. Initial screening demonstrates elevated late-night salivary cortisol levels. This is the most likely diagnosis, and this is the next best confirmatory test.
What is Cushing syndrome and dexamethasone suppression testing?
300
A 66-year-old woman presents with chronic fatigue and pruritus. Laboratory evaluation demonstrates isolated elevation in alkaline phosphatase. This antibody test is most specific for confirming the suspected diagnosis. (Diagnosis + test)
What is primary biliary cholangitis confirmed with antimitochondrial antibody (AMA) testing?
400
A 59-year-old man underwent screening colonoscopy that identified and removed 5 tubular adenomas, all measuring less than 10 mm without high-grade dysplasia. According to current surveillance guidelines, repeat colonoscopy is recommended at this interval.
What is repeat colonoscopy in 3 years?
400
A 2-year-old child presents with cough, wheezing, tachypnea, and increased work of breathing during viral season. Oxygen saturation is 96% on room air. RSV testing is positive. According to current evidence-based guidelines, this is the recommended management.
What is supportive care only?
400
A 46-year-old man presents after feeling a sudden “pop” in the back of his ankle while playing pickleball. He reports immediate pain and difficulty walking. Examination demonstrates weakness with plantarflexion. This bedside physical exam maneuver is most useful to confirm the suspected diagnosis.
What is the Thompson test — squeezing the calf while the patient lies prone and observing for absence of passive plantarflexion?
Achilles Tendon Rupture
400
A 78-year-old man presents after an episode of painless transient monocular vision loss lasting approximately 10 minutes that completely resolved. ECG demonstrates an irregularly irregular rhythm without discernible P waves. This transient visual symptom is most consistent with this diagnosis, likely secondary to this underlying condition.
What is amaurosis fugax caused by atrial fibrillation/cardioembolic disease?
400
A 68-year-old man with type 2 diabetes and CKD stage 4 presents for follow-up. His eGFR is 18 mL/min/1.73m² and A1c is 8.6%. Metformin is discontinued due to advanced renal disease. According to current guidelines, this agent may be initiated without renal dose adjustment.
What is linagliptin (Tradjenta)?
400
A 58-year-old man with bipolar disorder presents with progressive polyuria and polydipsia after many years of lithium therapy. Laboratory evaluation demonstrates hypernatremia and persistently dilute urine despite water deprivation testing. This medication is considered first-line treatment for his condition.
What is amiloride?
Nephrogenic diabetes insipidus secondary to lithium
500
A 64-year-old woman undergoes cotesting and is found to have ASC-US with negative high-risk HPV testing. She otherwise has an adequate prior screening history and no history of abnormal results. According to current AAFP guideline recommendations, when should repeat cervical cancer screening occur?
What is repeat cotesting in 3 years?
500
A 68-year-old man is hospitalized with severe community-acquired pneumonia requiring ICU admission. He presents with fever, productive cough, confusion, hyponatremia, and diarrhea after attending a hotel convention. According to current recommendations, this diagnostic test should be obtained, and this antibiotic class is the appropriate first-line treatment.
What is a Legionella urinary antigen test and treatment with a fluoroquinolone?
500
A 7-year-old child presents after falling on an outstretched hand while playing on the playground. Wrist radiographs are shown below.
What is the diagnosis, and what is the recommended management?
What is a distal radius buckle (torus) fracture treated with a removable wrist splint?
500
A 73-year-old woman with atrial fibrillation presents with melena and symptomatic anemia while taking apixaban. Endoscopy reveals active gastrointestinal bleeding. This reversal agent is used for life-threatening bleeding associated with factor Xa inhibitors.
What is andexanet alfa?
Reversals:
Dabigatran = idarucizumab
Xa inhibitors = andexanet alfa
Warfarin = PCC + vitamin K
Heparin = protamine
500
A 29-year-old woman presents with secondary amenorrhea and infertility several months after dilation and curettage for retained products of conception following postpartum hemorrhage. Laboratory evaluation demonstrates normal prolactin, TSH, FSH, and estradiol levels. This is the most likely diagnosis, and this is the gold standard diagnostic test.
What is Asherman syndrome diagnosed with hysteroscopy?
500
A 26-year-old pregnant woman at 18 weeks gestation presents with expanding annular erythema with central clearing following recent camping in Connecticut. She reports fatigue and arthralgias but no neurologic or cardiac symptoms. She reports developing a diffuse rash with amoxicillin as a child but denies any history of anaphylaxis. This is the most likely diagnosis, and this is the recommended treatment during pregnancy.
What is Lyme disease treated with cefuroxime axetil?
500
A 58-year-old woman presents with progressive proximal muscle weakness and violaceous discoloration of the eyelids. Examination demonstrates erythematous papules over the MCP joints. Laboratory evaluation reveals elevated CK levels. Muscle biopsy would most likely demonstrate perifascicular atrophy. Given this diagnosis, screening for this associated malignancy should also be considered.
What is ovarian cancer associated with dermatomyositis?