Bad Rhythms and Broken Hearts
Oncology and Ugly Blood
Liver and Gut Issues
New and Old Medicine
Infectious Tales
Policy Corner and More
Art of Preventing
100
What is the rhythm disorder?
Atrial Flutter
100
This rare leukemia presents with massive splenomegaly, pancytopenia, dry tap on marrow biopsy, and cells positive for TRAP stain and BRAF V600E mutation.
Hairy cell leukemia
100
This extraintestinal manifestation of IBD often parallels disease activity and presents with painful red nodules on shins.
Erythema nodosum
100
Often considered the first physician in recorded history, this ancient Egyptian polymath lived around 2600 BCE and served Pharaoh Djoser.
Imhotep
100
Use of femoral access, prolonged catheter duration, TPN infusion, and frequent line manipulation all increase the risk of this central line complication.
CLABSI (central line–associated bloodstream infection)
100
This ACGME component outlines the developmental steps from novice to expert across specialties and is used for semiannual evaluations.
ACGME Milestones
100
Women ages 21–29 should be screened for cervical cancer every 3 years using this test alone.
Pap smear
200
What is the treatment for a 89 yo M with the following rhythm abnormality?
Percutaneous Pacemaker
200
A patient with unexplained thrombosis and hemolysis is found to have DKK1 elevation, clonal hematopoiesis, and deficient CD55/CD59 on flow cytometry. This condition is treated with complement inhibitors such as eculizumab.
Paroxysmal nocturnal hemoglobinuria (PNH)
200
This liver disease presents with AMA-positive antibodies and is treated with ursodeoxycholic acid.
Primary biliary cholangitis (PBC)
200
This Dutch physiologist is credited with inventing the first practical electrocardiogram (ECG) in 1903.
Willem Einthoven
200
A positive test as seen, rising hematocrit, and falling platelets are early markers of a disease that is transmitted by the following vector:
Aedes aegypti
200
A resident discovers that Amion incorrectly lists them on two simultaneous shifts, which could trigger a duty-hour violation. According to proper scheduling workflow, the next best step is to do this.
Notify the chief residents or scheduling team immediately to correct the Amion schedule
200
Annual low-dose CT is recommended for adults aged 50–80 with a 20-pack-year smoking history who currently smoke or quit within this number of years.
15 years
300
This hemodynamic measurement is elevated in cardiogenic shock and helps differentiate it from hypovolemic shock.
Pulmonary capillary wedge pressure (PCWP)
300
This soluble immune marker is markedly elevated in HLH and reflects T-cell activation.
sCD25, also known as soluble IL-2 receptor
300
This scoring system predicts pancreatitis related mortality based on BUN, age, mental status, and SIRS and has replaced Ranson as first-line.
BISAP score
300
This British physician used epidemiology to trace cholera to a contaminated water pump in 1854.
John Snow
300
59 yo M frequent traveler to Africa presents with months-to-years of intermittent fever, lymphadenopathy, and progressive neuropsychiatric decline. Smear is seen here.
West African trypanosomiasis
300
A patient with severe aortic regurgitation has a wide pulse pressure and rapid rise-and-fall carotid pulse known as this classic sign.
Corrigan’s (or “water hammer”) pulse
300
Abdomen US must be used at least once in a lifetime to screen for abdominal aortic aneurysm in:
Men ages 65–75 who have ever smoked.
400
This antiplatelet agent is contraindicated in patients with a history of TIA or stroke due to increased bleeding risk seen in the CHARISMA trial?
Prasugrel
400
This oncogene mutation is the most common driver mutation in non–small cell lung cancer, especially adenocarcinoma, and predicts response to tyrosine kinase inhibitors.
EGFR mutation
400
A 60-year-old man has 1 tubular adenoma 12 mm in the ascending colon. Good prep, complete resection. When is his next colonoscopy?
3 years
400
This 2025 trial confirmed that cardiovascular protection from GLP-1 receptor agonists extends to oral formulations, marking a major shift in diabetes and ASCVD prevention.
SOUL Trial
400
A 30-year-old man returns from rural Brazil with a slowly enlarging painless ulcers on his forearm and legs that has raised edges and a granulating base. Wht is the Dx?
Cutaneous leishmaniasis
400
On lung ultrasound, the presence of multiple vertical comet-tail artifacts arising from the pleural line indicates this condition.
B-lines (suggesting pulmonary edema or interstitial syndrome)
400
According to CDC/ACIP, this group of adults should routinely receive the RSV vaccine:
Anyone ≥75 years old, and adults 60–74 years old who have chronic conditions such as COPD, CHF, asthma, diabetes, or frailty.
500
What is the diagnosis of the following rhythm disorder?
AVNRT
500
This antibody, strongly associated with small-cell lung cancer, causes a paraneoplastic syndrome with sensory neuropathy, cerebellar ataxia, or encephalomyelitis.
Anti-Hu (ANNA-1)
500
A 58-year-old man with compensated cirrhosis from NASH (MELD-Na 12, Child A), portal hypertension with known small esophageal varices, presents with new-onset atrial fibrillation. PLT 78k. What is the most appropriate next step regarding anticoagulation?
DOAC such as apixaban after ensuring variceal prophylaxis (nonselective beta-blocker or recent EGD).
500
In the 2025 VESALIUS‑CV trial, this PCSK9 inhibitor achieved a 25% relative risk reduction in the composite of coronary heart disease death, myocardial infarction, or ischemic stroke among patients with atherosclerosis or diabetes without prior MI or stroke.
Evolocumab
500
A 72 yo M returns from a July fishing trip in Cape Cod with 5 days of high fevers, dark urine, fatigue, and mild shortness of breath. Labs reveal Hgb 8.5, platelets 70,000, indirect bilirubin 3.5, LDH elevated, and low haptoglobin. Smear is seen. What is the Dx?
Babesiosis
500
This striking physical exam finding, a transient flushing of the face and upper chest when the arm is lifted above the head:
Pemberton’s sign
500
Patients with ulcerative colitis or Crohn’s colitis involving more than one-third of the colon should begin colorectal cancer surveillance this many years after symptom onset, followed by colonoscopy every 1–3 years.
8 years
600
For a patient in cardiac arrest with VT and a prolonged QTc, the safest antiarrhythmic is:
Lidocaine, avoid Amiodarone in this case
600
A patient with chronic hemolytic anemia presents with rapid-onset severe anemia, reticulocyte count near zero, and mild fever. Bone marrow biopsy shows giant pronormoblasts with intranuclear viral inclusions. This condition is caused by:
Parvovirus B19
600
A 42-year-old patient with chronic diarrhea, secretory stool pattern, hypokalemia, metabolic acidosis. Pt found to have a pancreatic tail mass on imaging. Pt also found to have achlorhydria and flushing. What is the Dx?
VIPoma
600
In a recent trial, _________ added to guideline-directed therapy in patients with HFrEF reduced the composite endpoint of all-cause mortality or hospitalization for worsening heart failure with a hazard ratio of approximately 0.82 after a median follow-up of 36 months.
Digitoxin
600
This antitrypanosomal medication, along with benznidazole, is one of the two FDA-approved treatments for acute and congenital Chagas disease, but is often limited by peripheral neuropathy and GI toxicity.
Nifurtimox
600
This rare cause of persistent hyperinsulinemic hypoglycemia in adults is characterized by diffuse pancreatic β-cell hyperplasia, often occurring after Roux-en-Y gastric bypass, and must be distinguished from insulinoma by selective arterial calcium stimulation testing.
Nesidioblastosis
600
According to current CDC guidelines, adults ≥65 years old who have never received a pneumococcal conjugate vaccine can meet all pneumococcal vaccination requirements with a single dose of this vaccine.
PCV20 (Pneumococcal Conjugate Vaccine 20-valent)
700
This test is the next best diagnostic step in a 63-year-old man with orthostatic hypotension, macroglossia, periorbital purpura, nephrotic-range proteinuria, restrictive cardiomyopathy, and an IgG-λ monoclonal spike.
Abdominal fat pad biopsy (for Congo red staining)
700
This is the most appropriate perioperative strategy for a 38-year-old woman with HbSS (baseline Hgb 7.9 g/dL) undergoing elective cholecystectomy to reduce sickling complications.
Preoperative simple transfusion to raise hemoglobin to about 10 g/dL?
700
This agent agent is most likely to induce and maintain remission of moderate to severe ileocolonic Crohn disease resistant to glucocorticoids or immunomodulators.
TNF-a inhibitor (Infliximab)
700
This SGLT2 inhibitor continued to demonstrate slowed kidney disease progression—even in patients without diabetes—in a recent JAMA extended analysis.
Dapagliflozin
700
This phase of chronic hepatitis B infection is characterized by a positive HBsAg, positive anti-HBc IgG, negative HBeAg, positive anti-HBe, normal ALT, and undetectable HBV DNA in a newly established patient from Somalia.
Inactive carrier phase of chronic hepatitis B (Immune control)
700
A 48-year-old man is evaluated for a 2-month history of a painless lesion on his left shoulder that has been increasing in size and is now 2 cm in diameter. Medical history is unremarkable. Skin findings are shown. What is the DX?
Nodular Melanoma
700
This diagnosis best explains persistent chest pain in a 46-year-old woman with 8 months of symptoms, normal cardiac and pulmonary testing, significant preoccupation with her symptoms, and repeated health-related internet searching—despite negative screens for depression and generalized anxiety disorder.
Somatic symptom disorder