Neuromania
Pump Fiction
Too Wheezy for This
The Gutfather
Sugar, Salt & Chaos
Fun facts
100
The best means to predict the risk of future falls in a patient with a history of backward falls is?
The pull test
100
Most common cause of apparent resistant hypertension
What is medication nonadherence?
Medication nonadherence is a discrepancy between how a medication is prescribed and how the patient is actually taking it.
Its prevalence in patients with apparent treatment-resistant hypertension is difficult to determine. Studies have shown it ranging from 3% to 86%, with a pooled estimate of 31% in a meta-analysis.
100
47 yo female rescued from a smoke-filled house
Na 150, K 5.0 Cl 100, HCO3 15, Lactic acid 10.0
High venous SPO2
Most likely Dx?
What is cyanide toxicity?
This blocks Cyp Complex IV, blocking:
- oxidative phosphorylation
- aerobic ATP production
So even though oxygen is present in the blood, cells are unable to utilize it.
100
Stool osmotic gap equation
What is 290 - 2*(stool Na + stool K)
Osmotic gap >100 suggests osmotic diarrhoea
100
56 yo man with poorly controlled T2DM. Fundoscopic examination . What is the diagnosis?
What is Nonproliferative Diabetic Retinopathy?
100
How many bones does the average adult human body have?
What is 206 bones?
200
What disease process is characterized by gait impairment, urinary incontinence, and cognitive change?
What is normal pressure hydrocephalus?
MRI of the brain first.
A trial of CSF drainage should not be attempted in the absence of enlarged ventricles on brain MRI.
200
Irregular R-R interval, 72 bpm, from these findings, what is most likely the Dx and management?
Management focuses on addressing underlying causes (Tx COPD, drug toxicity...)
200
32 yo male, waist circumference of 108 cm, Daytime PCO2 greater than 45mmHg, what is the Dx?
Pickwickian syndrome (OHS)
3 hypotheses for the pathogenesis of chronic daytime alveolar hypoventilation in OHS:
Hampered respiratory mechanics due to obesity
Central hypoventilation caused by leptin resistance
Pathologic compensatory response to acute hypercapnia
200
Most likely cause of chronic diarrhea in a patient with long standing Celiac disease who is compliant with gluten-free diet
Microscopic colitis
DDx of unresponsive celiac disease:
HIV infection, irritable bowel syndrome, small intestinal bacterial overgrowth, microscopic colitis, pancreatic insufficiency and small intestinal lymphoma (enteropathy associated intestinal lymphoma - EATL)
200
Hypoglycemic episodes, Insulin↑, serum C-peptide↑, pro-insulin↑ → urine meglitinide metabolites ⊕
Dx?
What is Surreptitious use of Oral Hypoglycemic agents?
200
This muscle is considered the strongest muscle in the human body based on force generated.
What is the masseter muscle?
300
In patients who have received intravenous rtPA, antiplatelet agents such as aspirin must be withheld for what time period?
What is at least 24 hours?
300
The only valvular conditions where warfarin is still preferred over DOACs (2)
What are mechanical valves and moderate-to-severe mitral stenosis?
300
Recurrence prevention is recommended after the first occurrence of secondary spontaneous pneumothorax.
What is pleurodesis?
Unlike primary spontaneous pneumothorax (healthy young thin patient), 2ry spontaneous PTX has:
- Higher mortality
- Higher recurrence risk
- Worse respiratory compromise
definitive recurrence prevention after the first episode
300
Work up and screening to be done in primary sclerosing cholangitis (mention 2/4)
-Colonoscopy and biopsy at time of diagnosis for IBD
-Annual or biannual MRCP and carbohydrate antigen 19-9 level for cholangiocarcinoma surveillance
-Annual US for gallbladder cancer
300
Autonomously functioning thyroid tissue; ↓TSH, ↑T4, ↑T3→thyroid scintrigraphy as shown
Toxic multinodular goiter
300
This is the only bone in the human body that does not directly connect to another bone.
What is the hyoid bone?
400
A 28-year-old man develops ascending weakness and areflexia 2 weeks after gastroenteritis. This therapy is NOT recommended because it does not improve outcomes in his condition.
What are corticosteroids?
400
Preferred fourth-line drug for resistant HTN per PATHWAY-2
What is spironolactone?
400
Antifibrotic agent indicated for the treatment of idiopathic pulmonary fibrosis.
pirfenidone (esbriet)
inhibiting fibroblast proliferation and collagen synthesis.
This slows the decline in lung function.
400
Sun-sensitive vesicular and bullous lesions in patients with chronic hepatitis C
Treatment?
Dx: Porphyria cutanea tarda
Phlebotomy, hydroxychloroquine, anti-viral therapy
400
Cushing Sx initial workup:
One of the following:
1. 24hr urine free cortisol (shift workers, estrogen use)
2. late-night salivary cortisol
3. 1mg overnight dexamethasone suppression test
#1 & #2 tests are often repeated twice on different occasions to confirm abnormal cortisol production.
400
This is the longest nerve in the human body.
What is the sciatic nerve?
500
A headache, in a female which is worse in the morning and with performing the Valsalva maneuver along with a history of tobacco and oral contraceptive use and with a finding a papilledema is most consistent with what diagnosis?
Dural sinus venous thrombosis
Dx test: magnetic resonance venography
500
What medication increases the risk of ventricular fibrillation in this patient?
What is beta blocker?
Bc, blocks AV nodal conduction and may increase conduction through the accessory pathway, raising the risk of ventricular fibrillation
500
This asthma therapy carries an FDA black box warning when used without ICS due to increased asthma-related mortality.
What is LABA monotherapy?
The SMART trial showed:
- increased asthma-related deaths
- increased life-threatening exacerbations
especially in:
- patients using salmeterol without inhaled corticosteroids (ICS)
This led to the FDA boxed warning.
The ICS-LABA combination remains the most effective strategy for preventing severe asthma exacerbations in those with persistent asthma.
500
Indications for IV albumin in spontaneous bacterial peritonitis
While all patients with SBP benefit from albumin administration, those with the following baseline parameters derive particular benefit:
1. Serum creatinine level > 1 mg/dL
2. BUN > 30 mg/dL
3. Total bilirubin level > 4 mg/dL
Dose protocol:
- Initial dose: 1.5 g/kg body weight at diagnosis (day 1)
- Follow-up dose: 1 g/kg body weight on day 3 3,1
- Albumin should be administered intravenously along with appropriate antibiotic therapy
500
High intensity statins? Mention at least 2 indications?
ASCVD patients, DM (ASCVD risk > 7.5%), LDL > 190;
1. atorvastatin 40/80
2. rousavastatin 20/40)
500
This is the only organ in the human body capable of functioning without a direct blood supply.
What is the cornea?