Avengers: EndOcardium
According to the 2025 ACC/AHA ACS guidelines, this oral P2Y₁₂ inhibitor is preferred over clopidogrel in patients with ACS undergoing PCI, unless contraindicated, because of its superior reduction in ischemic events.
What is Ticagrelor or Prasugrel? (Either is acceptable)
According to the 2025 ADA Standards of Care, in adults with type 2 diabetes and MASLD, which drug class is specifically recommended as part of the treatment plan for its potential benefits in managing steatotic liver disease?
GLP-1 receptor agonists.
Weight reduction, improved NASH/MASLD histology in trials (e.g., LEAN, semaglutide NASH trials)
The 2024 SCCM guidelines recommend this corticosteroid regimen for septic shock.
What is hydrocortisone 200 mg/day (avoid >400 mg/day equivalents -- recommendation from SCCM against high-dose/short-duration though in favor of the 200mg)? (specify dosage)
ADRENAL study (2018): hydrocortisone ~200 mg/day (continuous infusion) shortened time to shock reversal and ventilator/ICU days but did not reduce 90-day mortality.
APROCCHSS (2018): hydrocortisone 50 mg IV q6h + oral fludrocortisone 50 μg daily for 7 days reduced 90-day mortality vs placebo in septic shock.
Higher doses w/o benefit and associated with harm (GIB, myopathy, hyperglycemia, secondary infections)
This chromosomal abnormality, is named after the city where it was first identified and is characteristic of CML.
What is the Philadelphia chromosome?
This antimicrobial agent is recommended as first-line prophylaxis for Neisseria meningitidis exposure in close contacts.
What is Rifampin?
According to the 2024 AHA/ACC multisociety guidelines, in symptomatic obstructive hypertrophic cardiomyopathy patients who remain severely symptomatic despite maximally tolerated beta-blockers or non-dihydropyridine calcium channel blockers, this novel pharmacologic class is now recommended before considering septal reduction therapies.
What are cardiac myosin inhibitors (e.g., mavacamten)?
According to the 2022 ACG Clinical Guideline for Celiac Disease, in adults undergoing serologic testing for celiac disease, patients should be counseled regarding what prior to testing to avoid false-negative results.
ACG (and multiple sources) recommend patients should remain on a gluten-containing diet for testing; recommended durations in guidance vary but are generally 2–6 weeks (many sources use ≥6 weeks as common practice).
According to the 2022 Surviving Sepsis Campaign and ATHOS-3 trial, this synthetic vasopressor is indicated for refractory distributive shock, with a unique mechanism.
What is Angiotensin II (Giapreza) — acts at AT1 receptors → vasoconstriction.
These criteria, named after a UK city, are used to diagnose cerebral amyloid angiopathy on imaging.
What are the Boston criteria?
A 50-year-old patient with a chronic foot ulcer has mild localized redness comes in to the ED. MR Imaging suggests possible underlying bone involvement, what is the best next step according to IDSA diabetic foot osteomyelitis guidelines?
Obtain a bone biopsy or bone culture if feasible, because pathogen identification guides targeted therapy. Empiric antibiotics are deferred unless there is systemic infection or high-risk features.
A patient presents with 2:1 AV block. You perform a vagal maneuver, and the block worsens (more non-conducted P waves). According to the 2018 ACC/AHA/HRS bradycardia guideline, what is the most likely diagnosis and the appropriate next step?
What is Mobitz I (AV nodal block), and observation unless symptomatic?
Atropine or exercise (sympathetic drive): If conduction improves → AV nodal (supra-Hisian). If conduction worsens (more block) or stays the same → infra-Hisian.
Vagal maneuvers (carotid massage, Valsalva): If conduction worsens (more block) → AV nodal (supra-Hisian). If conduction improves (less block) → infra-Hisian.
Mobitz I / suprahissian block: Observation unless symptomatic (Class I: no pacing if asymptomatic).
Mobitz II / infrahissian block (or 2:1 where infra-Hisian suspected): Permanent pacing is Class I recommended, regardless of symptoms.
According to the 2024 AASLD Guidance for PBC, the first-line pharmacologic therapy for patients with PBC is this medication, which should be started as soon as diagnosis is confirmed, even if asymptomatic.
What is Ursodeoxycholic acid (UDCA)?
According to 2023 ARDS guidelines, what is the timing, patient selection, and minimum duration and ventilator target during proning?
What is early proning (within 36 hrs) for patients with "moderate-to-severe" ARDS PaO₂/FiO₂ ≤150 (150 was part of the inclusion criteria for PROSEVA trial), with >12h/day-16hrs sessions, maintaining lung-protective ventilation. Need all 3 for points (timing, P/F ratio, and minimum duration).
These criteria, developed in an Italian city, are used to select HCC patients for transplant.
What are the Milan criteria?
Key to know because (1) patients within criteria have much better survival post-transplant, and (2) liver cancer can be diagnosed without biopsy if classic imaging features are present (arterial enhancement + venous/delayed washout). This avoids biopsy risks like bleeding and tumor seeding.
^this is just teaching
A hospitalized patient with C. difficile colitis is hypotensive and has worsening abdominal pain despite standard oral vancomycin. According to IDSA/ATS guidelines, what is the recommended next step in management?
What is: Treat as severe or fulminant C. difficile infection with oral vancomycin plus intravenous metronidazole, and consider surgical consultation if the patient is hypotensive or develops toxic megacolon.
In a patient with LV noncompaction cardiomyopathy and an LV thrombus, according to the 2015 AHA Scientific Statement, which class of medication is recommended for anticoagulation, and for approximately how long?
What is: Vitamin K antagonists (warfarin), typically 3–6 months, with repeat imaging to confirm resolution. (DOACs are being used off label as of 2022 guidelines however most safety data is for warfarin)
According to the 2018 AASLD Hepatitis B Guidance, antiviral therapy is recommended for patients with chronic hepatitis B who have: elevated ALT and either HBV DNA above threshold or fibrosis. The preferred first-line agents are:
What is: Tenofovir or Entecavir (HBV DNA thresholds: >20,000 IU/mL if HBeAg+, >2,000 IU/mL if HBeAg–).
According to ELSO/ATS/SCCM guidelines, VV-ECMO should be considered in severe ARDS when conventional management fails. State the PaO₂/FiO₂ threshold, ventilation requirements, and timing.
What is: PaO₂/FiO₂ ≤80 mmHg for ≥6 hrs despite lung-protective ventilation (Vt 4–6 mL/kg, Pplat ≤30). Early initiation (6–24 hrs) before irreversible organ injury. (Need to give P/F ratio, and timing)
EOLIA Trial (NEJM 2018), Inclusion criteria for ECMO arm: PaO₂/FiO₂ <50 mmHg for >3 hours, OR PaO₂/FiO₂ <80 mmHg for >6 hours, OR, pH <7.25 with PaCO₂ ≥60 mmHg for >6 hours (hypercapnic respiratory failure).
There is also the 2009 CESAR trial in LANCET which established that ECMO center referral improved survival without disability (done in the UK).
A patient with fever, jaundice, RUQ pain, labs with cholestasis, and biliary dilation on imaging. According to guidelines named after a city, what are the guidelines and the 3 main diagnostic criteria?
What are the Tokyo Guidelines; systemic inflammation, cholestasis, imaging findings. (Need to say the city + 3 criteria for points)
A 68-year-old ICU patient with a ventilator-associated pneumonia grows Acinetobacter baumannii resistant to all carbapenems. According to current IDSA guidance, what first-line treatment options are recommended, and what is the mainstay of infection control to prevent spread? (Name 2 first lines + an alternative — need all 3)
What is IV colistin or polymyxin B. Cefiderocol in select cases (is also accepted). Infection control: Strict contact precautions (gloves, gowns), Environmental cleaning and hand hygiene
This is the most common congenital heart defect diagnosed (not prevalence) but diagnosed in adulthood, and according to the 2020 ACC/AHA Adult Congenital Heart Disease Guidelines, Class I indications for closure include:
What is: Secundum ASD; with right heart enlargement, Qp:Qs ≥1.5:1, and PVR < 5 WU. (Need to name the defect + all 3 criteria needed to proceed with closure for points)
2020 ACC/AHA Adult Congenital Heart Disease Guidelines. Not based on any individual RCT but years of observational data.
According to ASGE guidelines, AXIOS lumen-apposing metal stents are used for drainage of pancreatic collections. Compared with plastic stents, these reduce interventions but carry a unique risk that must be monitored.
What is delayed bleeding (erosion), stent migration, or buried stent syndrome?
A tracheostomy patient develops massive, pulsatile bleeding. This rare but catastrophic complication most often occurs 3–4 weeks post-procedure. Name the condition and the immediate maneuver.
What is tracheoinnominate fistula; overinflate cuff, apply Utley maneuver (finger through incision to apply direct pressure to artery), emergent surgical repair (call CT surgery emergently). (need to name complication and maneuver to stabilize and who to call -- all 3 for points)
After lymphoma treatment, PET/CT shows residual FDG uptake. According to classification named after a city, what scale is used, and what indicates complete response?
What is the Lugano classification using the Deauville 5-point scale. Complete response: score 1–3.
Need all 3
A 28-year-old man who has sex with men reports multiple partners and inconsistent condom use. He is HIV-negative. According to CDC and USPSTF guidelines, what medications and dosing strategies are recommended
What is Daily oral tenofovir disoproxil fumarate (TDF) + emtricitabine (FTC). Alternative: Tenofovir alafenamide (TAF) + FTC for men who have sex with men. On-demand (2–1–1) dosing can be used for MSM in select settings. HIV testing: Every 3 months while on PrEP