Y
W
I
M
R
100
Patients with ulcerative colitis or Crohn's disease are at increased risk for this disease, regardless of recent antibiotic use or hospitalization
C difficile colitis
100
This group of medications should be used with caution in cases of cerebral irritability as they can paradoxically worsen agitation and delirium (i.e. in patients with alcohol withdrawal or ventilated patients)
Benzodiazepines
Benzodiazepines have a more rapid onset of action than antipsychotics, but they can worsen confusion and sedation. In a prospective study of ICU patients, lorazepam was an independent risk factor for incident delirium, increasing the risk by approximately 20 percent. In two randomized trials of sedative treatment in mechanically ventilated ICU patients, the benzodiazepine midazolam was associated with significantly more delirium compared with dexmedetomidine treatment (77 versus 54 percent).
100
The most accurate measurement of a patient's bicarbonate level is obtained from this laboratory study
BMP
When a BMP is obtained at the same time as an ABG, the bicarbonate level from the BMP should be used as the ABG value is a calculated number
100
Don’t prescribe oral antifungal therapy for suspected nail fungus without __________.
What is confirmation of fungal infection?
Choosing Wisely Recommendation (American Academy of Dermatology): Don’t prescribe oral antifungal therapy for suspected nail fungus without confirmation of fungal infection. Approximately half of nails with suspected fungus do not have a fungal infection. As other nail conditions, such as nail dystrophies, may look similar in appearance, it is important to ensure accurate diagnosis of nail disease before beginning treatment. By confirming a fungal infection, patients are not inappropriately at risk for the side effects of antifungal therapy, and nail disease is correctly treated.
100
Clinicians should reserve antibiotic treatment for _________ for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39 °C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening).
What is acute rhinosinusitis?
200
Don’t perform __________ as routine follow-up for mild, asymptomatic native valve disease in adult patients with no change in signs or symptoms.
What is echocardiography?
Choosing Wisely Recommendation: Don’t perform echocardiography as routine follow-up for mild, asymptomatic native valve disease in adult patients with no change in signs or symptoms. Patients with native valve disease usually have years without symptoms before the onset of deterioration. An echocardiogram is not recommended yearly unless there is a change in clinical status.
200
Goal serum urate level in patients with a history of gout on long-term urate-lowering therapy
<6mg/dL
200
Don’t perform imaging of the carotid arteries for simple syncope without _______________.
What are focal neurologic symptoms?
Choosing Wisely Recommendation (American Academy of Neurology): Don’t perform imaging of the carotid arteries for simple syncope without other neurologic symptoms.
200
Contraindication for performing a pharmacological stress test with adenosine
Known bronchoconstrictive/bronchospastic lung disease with active wheezing
200
Options for the treatment of an acute gout flare
NSAIDs, steroids, or colchicine
300
sustained intra-abdominal pressure >20 mmHg (with or without abdominal perfusion pressure <60 mmHg) that is associated with new organ dysfunction
What is abdominal compartment syndrome?
300
Name 2 indications for bariatric surgery
-BMI > 40 without comorbid illness
-BMI 35-39 with at least 1 comorbid condition (i.e. DM2, OSA, HTN, HLD, OHS)
-BMI 30-34.9 and uncontrolled DM2 or metabolic syndrome
300
Mature pancreatic collections (i.e. pancreatic pseudocyst, walled-off pancreatic necrosis) typically develop ____ weeks after an episode of acute pancreatitis
4 weeks
300
Name 2 indications for urate-lowering therapy in a patient with a history of gout
history of frequent (i.e. 2+ annually) or disabling gout flares
clinical or radiographic signs of chronic gouty arthritis
tophaceous deposits in soft tissues or subchondral bone
renal insufficiency (stage 3 or higher CKD)
300
Name 3 scoring systems used to estimate the risk of MACE/mortality in patients with ACS
TIMI, GRACE, HEART
400
Name 1 patient presentation consistent with a high pretest probability of CAD (i.e. _____ angina in women/men age _____)
High (>90%): typical angina in men 40+, typical angina in women 60+
Intermediate (20%-80%): atypical angina in men of all ages, atypical angina in women age 50+, typical angina in women age 30-50
Low (<10%): asymptomatic people of all ages, atypical chest pain in women age <50
400
"Wherever the art of Medicine is loved, there is also a love of Humanity"
Hippocrates
400
The decision to treat for this often fatal condition should typically be based on clinical suspicion rather than on the result of a CSF PCR (given the frequency of false negatives)
HSV encephalitis
400
6 P's of acute limb ischemia
pain, poikilothermia, pallor, pulselessness, paresthesias, paralysis
400
"To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.”
Sir William Osler
500
This level of serum triglycerides is typically associated with acute pancreatitis due to hypertriglyceridemia.
>1000 mg/dL
500
ASH guideline panel suggests using _______intensity anticoagulation in patients with COVID-19–related critical illness who do not have suspected or confirmed VTE.
ASH guideline panel suggests using prophylactic-intensity over intermediate-intensity or therapeutic-intensity anticoagulation in patients with COVID-19–related critical illness who do not have suspected or confirmed VTE.
500
4 features a patient with a maximal 4Ts score would have
500
Specific reversal agent for major bleeding in patients taking dabigatran
idarucizumab
500
"The glory of medicine is that it is constantly moving forward, that there is always more to learn. The ills of today do not cloud the horizon of tomorrow, but act as a spur to greater effort."
William Mayo
600
Asymptomatic pregnant patients with ITP and a platelet count greater than ______ can be monitored without any treatment
30000
600
Specific reversal agent for patients with major bleeding on apixaban or rivaroxaban
andexanet alfa
600
Name 2 criteria in the diagnosis of polycythemia vera (major or minor)
Major criteria
- Hemoglobin >16.5 g/dL in men/Hemoglobin >16.0 g/dL in women
or
Hematocrit >49% in men/Hematocrit >48% in women
or
Increased red cell mass*
- Bone marrow biopsy showing hypercellularity for age with trilineage growth (panmyelosis) including prominent erythroid, granulocytic, and megakaryocytic proliferation with pleomorphic, mature megakaryocytes (differences in size)
- Presence of JAK2 V617F or JAK2 exon 12 mutation
Minor criterion
- Subnormal serum erythropoietin level
Diagnosis of PV requires meeting either all 3 major criteria, or the first 2 major criteria and the minor criterion¶
600
Name of the receptor that the COVID-19 virus attaches to in the intestinal endothelial cells
ACE-2 receptor
600
GI manifestations are seen in up to _____% of COVID-19 cases (correct answer should be within 10% of the upper end of the range)
700
List the general treatment regimen for:
-primary, secondary, and early latent syphilis
-late latent and tertiary syphilis AND
-neurosyphilis at any stage
- 1 dose of IM PCN for primary, secondary and early latent syphilis
- 3 weekly doses of IM PCN for late latent and tertiary syphilis
- 14d of IV PCN for any neurosyphilis at any stage