Executive Overdrive
Structural Integrity
Growth at All Costs (Spaced Repitition)
The Price is Right
Desert Startup Summit
100
53 y/o M w/ cushinoid symptoms follows up after initial testing showing post-dexamethasone suppression reveals an AM cortisol of 10 and an ACTH of 22. Name 2 causes of cushing's syndrome that could lead to these results
Cushings disease 68%
Ectopic ACTH production 12%
CRH producing tumor <1%
Low ACTH makes up the other 20% (ACTH independent)
100
What is a "bisphosphonate holiday" and when should you consider it for patients?
Break from bisphosphonate use - they stay metabolically active in the bones for a long time after discontinuation.
Patients at low-medium risk of fracture after 5 years of oral bisphosphonate or 3 years of IV bisphosphonate. High risk should continue (T score still < 2.5, hip/vert fracture, ongoing steroids).
Increased risk of atypical femur fractures proportional to duration of use.
Typically 2-5 years, then re-assess (DEXA usually covered q2yr)
100
What is the classic antibody seen in autoimmune encephalitis?
anti-N-methyl-D-aspartate receptor (NMDAR)
Also accept anti-Hu [SCLC], anti-Ma2 [testicular], anti-CRMP5 [SCLC/thymoma], anti-NMDA receptor [ovarian teratoma, idiopathic]
100
Strep Pneumo Antigen
$313
sensitivity of 50–86% and a specificity of 90–95%
PUATs should not be routinely included in the CAP diagnostic workup. First, the pretest probability of a positive test is low because most tests are negative. Second, positive results do not alter antibiotic management in most cases because all recommended empiric antibiotic regimens for CAP have in vitro activity against S pneumoniae. However, positive results do not exclude the presence of other pathogens, for which premature de-escalation based purely on the PUAT result may lead to negative consequences, such as increased clinical relapse.
100
A traditional cheer from what cultural background was mistaken for a yodel, and called "wierd" by Sabrina Carpenter, sparking backlash amongst her fans.
A traditional Arabic cheer during Arab American Heritage (not Inheritence) Month called a zaghrouta.
200
What should you be concerned about if you identify hypersecretion of multiple adrenal hormones?
Adrenocorticoid Cancer - 40% of functional adrenocorticoid ca secretes multiple hormones due to loss of normal steroid regulation. Most commonly cortisol + androgens.
Adenomas rarely secrete more than one.
200
What is the preferred formulation of calcium supplementation in patients with osteoporosis on PPI or H2 blocker?
Calcium citrate is water soluble and does not require acidic environment for absorption
Calcium carbonate requires acid for absorption. There is a question of whether calcium carb at mealtimes has better efficacy, but just switch to citrate.
Fractional calcium absorption in achlorhydric patients was 0.452 for citrate vs. 0.042 for carbonate - 10 fold difference
200
In a patient with SIADH 2/2 SCLC, what might you expect the urine sodim and urine osmolality to be?
Uosm >100 - ADH is on
UrNa >30 - RAAS is off (as long as patient has adequate sodium intake)
200
Procalcitonin
$325
Can't order at RWJ, Princeton has procal pathway
Penn Pathway (on Intranet)
Expected to rise 2-4 hours after infection, peak 6-12 hours, half life of 24 hours
Other inflammatory causes or anti-inflam meds do NOT affect it
Careful interp in
More likely false positive CKD/ESRD, major stressors, pancreatitis, fungal/parasitic inf, age>80, cardiac arrest
More likely false negative immunocompromised, closed-spaced infections (abscess) or intracellular bacteria (legionella, mycoplasma)
200
Which actor restored the power to save Sabrina Carpenter’s headlining set?
Will Ferrell - He dragged a heavy plug across the stage, tried to light a cigarette (but failed due to the high winds), and ultimately plugged the cord in, resulting in sparks flying and lights flickering.
300
What three tests are used initially to evaluate for Cushing's disease?
Dexamethasone suppression test
Late-night salivary cortisol
24 hour urine cortisol
300
Name 3 indications for bisphosphonates
Fragility fracture i/s/o osteopenia (can have mildly reduced bone density but still very brittle bone structure) - no associated trauma or trauma equivalent to falling from a standing height or less
T-score ≤−2.5 at the lumbar spine, femoral neck, total hip, or 33% radius. Each standard deviation reduction below a T-score of 0 is associated with a doubling or tripling in fracture risk.
Hip or vertebral fragility fracture (regardless of T-score) or Osteopenia with fragility fracture of proximal humerus, pelvis, or distal forearm
Osteopenia (T-score −1.0 to −2.5) with high FRAX probability: ≥3% for hip fracture or ≥20% for major osteoporotic fracture
Planned long-term glucocorticoid use + osteopenia.
Men receiving androgen deprivation therapy and women on aromatase inhibitors have specific FDA-approved indications for denosumab to increase bone mass.
Hypercalcemia of malignancy, skeletal mets, Paget's, and OI also acceptable.
300
Name 4 reasons why a patient should undergo a colonoscopy, rather than FIT/Cologuard for CRC screening?
Anyone at above average risk
Genetic syndrome
IBD w/ >1/3 colon
SYMPTOMS - IDA, Hematochezia / melena, Unintentional weight loss, Change in bowel habits
Stong family hx
Prior colonoscopies with CRC or Advanced adenomas
300
Echocardiogram
$4,119
The cardiologists and echo techs are getting spread thin by unnecessary bubble studies and stat ordering of echos. Bubble studies should only be ordered when c/f paradoxical embolism which you would treat (PFO in someone likely to be a candidate) or hypoxia leading to shunting physiology that will change management. STAT echos should only be ordered for emergencies, such as concern for tamponade or new right heart strain from massive embolism.
300
What year of trendy clothing dominated the fashion scene at Cochella?
2016
Viral trend called 2026 is the new 2016, where people are reviving mid-2010s aesthetics complemented by Y2K accents, modern boho/desert western textures, sheer/maximalist layering
- Denim shorts, band tees, flannels
- Chokers, stacked necklaces
- Effortless “tumblr-era” cool
400
Name 3 classes of anti-HTN medications that can cause a renin/aldosterone ratio to be normal in a patient who truly has primary hyperaldosteronism (false negative)
MRAs (functional volume depletion, increased renin disproportionately) - stop 1 month prior
ACE/ARBs (decreased angiotensin - decreased aldosterone, increased renin) - stop 2 weeks prior
Diuretics (volume depletion -> increase renin disproportionately) - stop 2 weeks prior
Dihydropyridine calcium channel blockers also mildly increase renin
False positive - BB, A2 agonists, NSAIDs
No effect - non-DHB CCB, hydral
400
Which groups of men does the Endocrine Society Guidelines recommend routine screening for osteoporosis?
Men > 70.
Men 50-69 with RF (low body weight, prior fracture and smoking).
USPSF does not endorse this currently, they say insufficient evidence.
Men account for 29% of osteoporotic fractures in the US, and 1 in 3 men who experience a hip fracture will die within a year - as population continues to age this may increase.
400
What are the three lab tests used to work up a protein gap, and what is each designed to detect?
SPEP → Is there a monoclonal protein?
IFE → What exactly is it?
FLC → Are there excess free light chains (esp. occult disease)?
400
Cervical MRI w and wo contrast (hint, add $8000 and to the price of a cochella ticket for the first weekend)
$8,649
$649 for a ticket to cochella first weekend
400
This unlikely pop star/politician pairing was spotted still going strong at Coachella this year
Katy Perry + Justin Trudeau
500
What adrenal incidentalomas require testing for
Mild autonomous cortisol secretion
Primary aldosteronism
Pheochromocytoma
Hyperandogenism
MACS - all patients - dex suppression test
1 Aldo - HTN or hypok - PAC/PRA ratio
Pheo - >10 HU on CT - 24 hour urine metaneph + free metaneph
Hyperandrogenism - suggestive symtpoms like hirsuitism/virilization - testost, DHEAs, androstenedione
500
Your 70 year old F patient with osteoporosis, HTN and HLD feels she is taking too many medications. Her medications include Vit D, calcium, amlodipine, atorvastatin and denosumab, which she has been taking for 2 years. In particular, she is tired of coming in for denosumab shots and requests to stop them. DEXA 1 month ago showed mild improvement in T-score from 2.8 to 2.6. Her cr is at baseline 0.7. What should you do about her osteoporosis when stopping denosumab?
When stopping denosumab/anabolic agents, patients have a rebound phenomenon with rapid bone loss and up to 8–10% risk of multiple vertebral fractures within the following year. They MUST be bridged with bisphosphonates on discontinuation of these medications. At least one year, but currently this is not well-studied.
500
Darier's sign, a skin reaction where rubbing or scratching a skin lesion causes it to become itchy, red, and swollen (urticated) within 2-5 minutes, is a classic finding in which disorder of myeloproliferation?
Systemic mastocytosis - specifically when it is cutaneous
500
What was Chris Gilligan's salary in 2024 (excluding bonuses)?
$773,692 and $96,800 bonus
500
What three artists headlined cochella this year?
Justin Bieber, Sabrina Carpenter and Karol G (first time hispanic artist has headlined)