Arab American Heritage
Nephro Madness
Be One with the Colonoscope
Non-Colorectal Cancer Detection
The Red Carpet
100
Describe the relationship between the Arab ethnicity and MENA.
MENA refers to people from a region spanning:
- Middle East: Saudi Arabia, Iran, Israel, Turkey
- North Africa: Egypt, Morocco, Algeria
Most ethnically arab populations are included in the geographic region of MENA.
100
Define nephrotic range proteinuria
≥3.5 grams of protein in 24 hours (24-hour urine collection)
OR
Urine protein-to-creatinine ratio (UPCR) ≥3.5 g/g
OR
Urine albumin-to-creatinine ratio (UACR) ≥2.2 g/g (≈2200 mg/g)
100
45 y/o with no PMH has his first colonoscopy. 3 polyps are removed during his colonoscopy. There is a 6 serous adenoma, 4 mm villous adenoma, and a 2 mm hyperplastic polyp. When should he have a follow up colonoscopy? Why?
Advanced adenomas - 3 years
100
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)
100
Which oscar nominee received public backlash after saying they "didn’t want to work in areas like ballet or opera who no one cares about anymore"?
Timothy Chalamet - thank god he lost to Michael B Jordan
"And I don't want to be working in ballet or opera, or you know things where it's like, 'Hey, keep this thing alive,' even though like no one cares about this anymore"
200
What is the word for depression in Arabic?
There wasn’t a widely used medical concept equivalent to modern depression.
Though the word now is اكتئاب (iktiʾāb)
200
In a patient for whom you are concerned for membranous nephropathy, a positive ____ test can obviate need for biopsy.
PLAR-2
Levels also predict prognosis. High levels = bad. Can also be monitored after treatment, and should hit 0 after treatment. if they start rising again may need to retreat.
200
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
200
What cancers are comercial insurance companies obligated to provide transportation to appointments for screening/diagnostic purposes?
Cervical and breast cancer screening per talk yesterday. Should be expanded to all
Medicaid has this expansion to all
200
What is the first K-pop song to win an Oscar?
Golden - Kpop Demon Hunters
300
A 28-year-old man of Arab American descent presents for a routine physical examination. He reports no symptoms and denies fatigue, bleeding, or weight loss. He takes no medications. Physical examination is unremarkable with no pallor, jaundice, or splenomegaly.
Hg 11.8 g/dL, HCT 36% MCV 68 RBC 5.8 million/μL (normal: 4.5-5.5 million/μL) RDW: 13.5% (normal: 11.5-14.5%),
WBC 7,200/μL
Pl 285,000/μL
Ferritin 95 ng/mL
Iron 88 μg/dL
TIBC 310 μg/dL
Transferrin Sat 28%
What is the most likely diagnosis, and the next step in management?
Thalessemia - Hg electrophoresis to identify A/B
High prevalence of both in Arab populations.
MCV VERY low (often <70)
Mentzer index = MCV/RBC <13; high Sp for thalessemia
300
How does ANCA vasculitis appear on kidney biopsy under immunofluorescent microscopy? Why does it look this way?
Pauci-immune - no deposits
ANCAs (against PR3 or MPO) bind circulating neutrophils
This causes neutrophil activation → adhesion to glomerular capillaries
Activated neutrophils degranulate + release ROS and enzymes
→ Direct endothelial injury and necrosis of glomerular capillary loops
300
Name 2 medications that are associated with microscopic colitis?
NSAIDs, PPIs, SSRIs
Also statins, H2 blockers.
300
A 78-year-old woman is evaluated for a rapidly growing, painful nodule on the right dorsal hand that appeared 6 weeks ago. Medical history is unremarkable, and she takes no medications.
Skin findings are shown.
What is the most likely diagnosis, and what is the next step in management?
Actinic keratosis
BCC
Keratoacanthoma
Pyoderma gangrenosum
Sporotrichosis
Keratoacanthoma (subtype of SCC) - rapidly growing, tend to involute and self-resolve
However, must have surgical excision (Moh's in this case as on hand) to rule out SCC
300
How many Oscars was Sinners nominated for?
16 - beating the previous record of 14 (though notably was nominated for casting, which was only added this year)
Picture, director, actor, supporting actor, suporting acress, original screenplay, casting, cinematography, film editing, costume design, makeup, score, song, production, sound, visual effects
400
A 28 y/o Arab American woman w/ no PMH presents to your clinic with a fever and dysuria and is found to have a UTI. You know this UTI is complicated, and rightly prescribe bactrim instead of nitrofurantoin to treat it.
Three days later, the patient returns to the ED with complaints of severe fatigue and dark urine. She reports that her urinary symptoms resolved after starting the antibiotic. She denies recent travel or other new medications. Vitals sig for tachycardia.
Hg 7.2 g/dL baseline unknown, HCT 22%, MCV 88 fL, Reticulocyte count: 8.5%, WBC 9.8, Pl 245K
Total bilirubin 4.8, Indirect bili 4.2
LDH 680, Haptoglobin 10, Urinalysis, Coombs is negative. Dark brown urine, positive for hemoglobin, negative for RBCs, noninfectious appearing. G6PD level is normal.
What is the most likely diagnosis?
G6PD deficiency - 6-33% of Arab populations
G6PD levels are often normal in an attack - check 4 weeks later and repeat in 3 month if negative
Classic triad: Fatigue, jaundice, and dark urine (hemoglobinuria)
Timing: Hemolysis typically occurs 24-72 hours after drug exposure, with anemia worsening until days 7-8
400
Name one medication or class of medications that can cause minimal change disease
NSAIDs - most common, and most tested
Lithium
Interferon
Immune checkpoint inhibitors - T-cell mediated
400
What is the SHIELD test for colorectal cancer?
Blood-based screening test for colorectal cancer developed by Guardant Health that was FDA-approved in 2024.
Sensitivity for CRC: ~83–90%
Specificity: ~90%+
Lower sensitivity for advanced adenomas/precancerous polyps - not yet incorporated into guidelines
Appropriate if refuse all others, including stool tests
400
What two malignancies make up the majority of cases of paraneoplastic encephalitis?
SCLC - prevalence 0.5-3% - represents 40-60% of paraneoplastic encephalitis
Ovarian teratoma prevalence 1-4% - 20% of paraneoplastic encephalitis
Thymoma 1-2%
Testicular germ cell tumors <1%
Breast 0.1-0.5%
400
For the cold open of the Oscars, host Conan O'Brien dressed up as the main antagonist of which film?
Weapons - Aunt Gladys
Amy Madigan won best actress for playing the role
500
A 28-year-old Arab American man presents to your clinic with a 10-year history of recurrent episodes of fever, severe abdominal pain, and chest pain. Each episode lasts 1-3 days and resolves spontaneously. He reports approximately 8-10 attacks per year. During attacks, he experiences temperatures up to 39.5°C (103°F), diffuse abdominal pain, and pleuritic chest pain.
Laboratory studies during one of his attacks show leukocytosis WBC 15K, CRP 120 mg/L, and ESR 85.
What is the most likely diagnosis and the first line treatment for this patient?
Colchicine is the first-line treatment for Familial Mediterranean Fever, typically dosed at 1.2-2.4 mg daily in adults. Colchicine prevents inflammatory attacks, controls subclinical inflammation, and reduces the long-term risk of AA amyloidosis in the majority of FMF patients.
IL-1 inhibitors if fails colchicine
500
According KDIGO glomerular disease guidelines, what four non-disease modifying medications should be considered in most patients diagnosed with a nephrotic condition?
ARB/ACE - yes
Statin - yes
Loop diuretics - yes if symptomatic w/ edema
Consider anticoagulation in select patients at increased risk.
- MN AND albumin <2–2.5
- OR nephrotic syndrome + multiple VTE risk factors
- AND bleeding risk is low
Additional meds can be considered, and may be added in future guidelines - Vitamin D, SGLT2 inhibitor, MRA, Aspirin if not anticoag, pneumocystis ppx
500
What endocrinopathy condition requires colonoscopy at the time of diagnosis?
Patients with acromegaly (excess growth hormone, usually from a pituitary adenoma) have:
↑ risk of colorectal adenomas
↑ risk of colorectal cancer
Mediated by: elevated insulin-like growth factor 1 → promotes cellular proliferation and inhibits apoptosis in colonic mucosa
500
What genital malignancy in females became the new leading killer (compared with other genital malignancies) in 2024 by a margin that is projected to continue to increase?
Endometrial - mainly driven by rising obesity
Relative Risk (RR) ≈ 1.5–1.6 per 5 BMI units
🔹 Overweight Risk is ~1.5–2× that of normal-weight women.
🔹 Class I Obesity Risk is 2–3× higher.
🔹 Class II Obesity Risk is 3–5× higher.
🔹 Class III Obesity Risk is 7–10× higher
500
For 97 years, this Oscar category had never been won by a woman - a streak that ended this year
Cinematography
Autumn Durald Arkapaw won for Sinners
Only 3 women have been nominated in 98 years