Breathless
On my nerves
Insane in the Brain (Death)
Out to lunch
Joint Resolutions
200
What imaging metric is now explicitly recommended over subjective visual quantification for risk stratification on a CT pulmonary angiogram?
The numerical RV/LV ratio.
200
The target of autoantibodies in Lambert-Eaton Myasthenic Syndrome (LEMS).
Antibodies against voltage-gated calcium channels (VGCC) associated with small cell lung cancer
200
A patient with classic locked-in syndrome may appear comatose, but astute clinicians may observe this ability to be preserved
Vertical eye movement
(Will also accept blinking)
200
This adjective is unlikely to describe the personality of someone with normal pressure hydrocephalus, but it might be used to describe their gait...
Magnetic
200
What autoantibody has the highest specificity for Rheumatoid Arthritis?
Anti-cyclic citrullinated peptide (Anti-CCP).
400
Post-PE patients should be screened at every visit for at least 1 year to rule out what chronic complication?
Chronic thromboembolic pulmonary disease (CTEPD/CTEPH)
400
A woman has 2 days of progressive, ascending, symmetric weakness, proximal and distal sensory deficits, and absent deep tendon reflexes following an episode of bloody diarrhea.
What is the most likely infectious organism?
20-40% of Guillain-Barré syndrome cases 2/2 Campylobacter jejuni
CMV (4-13% of cases) and EBV (1-10% of cases), Mycoplasma pneumoniae (5-10%) Zika virus also implicated
molecular mimicry: C. jejuni lipooligosaccharides are identical to gangliosides GM1 and GD1a on peripheral motor axons
400
This ancillary test can confirm brain death with the so-called "hollow skull sign"
Cerebral scintigraphy/radionuclide perfusion scan
400
This is the definitive treatment for normal pressure hydrocephalus to improve gait velocity and mobility
Ventriculoperitoneal shunt placement
400
A patient presents with daily spiking fevers, a salmon-colored macular rash, and inflammatory arthritis. What is the most likely diagnosis?
Adult-onset Still's disease
600
What diagnostic evaluation should be completed in a patient with persistent dyspnea or exercise limitation at least 3 months after acute PE?
diagnostic evaluation:
TTE alone is insufficient to include or exclude a diagnosis of CTEPD
negative predictive value of planar V/Q to exclude a diagnosis of CTEPD approaches 100%.
SPECT perfusion imaging combined with low-dose noncontrast CT (SPECT/CT) and V/Q SPECT have similar diagnostic performance
600
In patients with hypothyroid myopathy, percussion of the muscle can provoke this specific phenomenon, which notably appears electrically silent on an EMG.
Muscle mounding or myoedema
600
A comatose patient whose eyelids open when you do this is likely displaying a spinal reflex
Painful nipple stimulation
600
This is a typical feature of Alzheimer disease seen on brain MRI
Bilateral hippocampal atrophy (top; normal hippocampi on bottom)
600
Which vasculitis is strongly associated with Hepatitis B infection and presents with mononeuritis multiplex (asymmetric sensory and motor deficits e.g., foot drop, wrist drop, hand weakness)?
Polyarteritis Nodosa (PAN)
800
The guidelines strongly recommend involving a multidisciplinary Pulmonary Embolism Response Team (PERT) for which specific AHA/ACC PE Clinical Categories?
A PERT assessment is recommended for patients in Categories C, D, and E.
800
identify one fundamental similarity OR difference between myotonia and paramyotonia.
Myotonia improves with repeated exercise; paramyotonia is worsened by exercise.
Both myotonia and paramyotonia are worsened by exposure to cold
800
You probably shouldn't test the oculocephalic reflex in a patient with an unstable C-spine, but you might test this reflex (also involving CN XII) instead.
Daily Double: Double points if you can describe the expected response in a fully neurologically intact patient
Oculovestibular reflex (aka caloric response)
Neurologically intact patient:
Instillation of cold water into the ear canal: eyes turn toward ipsilateral ear, with horizontal nystagmus to the contralateral ear.
Instillation of warm water into the ear canal: eyes turn toward the contralateral ear, with horizontal nystagmus to the ipsilateral ear.
800
These are the two disease-modifying therapies for mild Alzheimer disease
Lecanemab and donanemab (monoclonal antibodies targeting the amyloid protein)
800
When a patient is taking azathioprine, tracking this specific erythrocyte index on a CBC is a useful way to assess medication compliance.
Mean Corpuscular Volume (MCV), as macrocytosis is common
1000
A patient with acute PE is hemodynamically unstable and in cardiogenic shock (E1). Your facility does not have capabilities for surgical embolectomy or catheter-based interventions. What is the recommended immediate course of action before considering transfer?
Immediate stabilization with intravenous systemic thrombolysis should not be delayed for transfer.
1000
These are two of the 3 indications for thymectomy in myasthenia gravis in the absence of thymoma.
- need to minimize immunotherapy in patients who have active disease and anti-AchR Ab
- age < 65 years
- within 3 years of diagnosis
1000
An apnea test is considered positive when there is no observable respiratory response in a patient with these two laboratory criteria (only 1 correct needed for points)
1. pH <7.28
2. PaCO2 >60 or >20 above patient's baseline
1000
Name one test other than a brain MRI that can be used to support a diagnosis of Alzheimer disease and help determine suitability of antiamyloid therapy.
1. Amyloid PET scan
2. CSF analysis showing decreased beta-amyloid protein (due to consumption in extracellular plaque formation) and increased total and phosphorylated tau (due to impaired metabolism)
1000
Tumor Lysis Syndrome is characterized by hyperuricemia, hyperkalemia, and hyperphosphatemia. What electrolyte abnormality completes the classic tetrad?
Hypocalcemia