Gut Instinct
(GI)
(GI)
Bug me Not
(Infectious Disease)
(Infectious Disease)
Urine Luck!
(Nephrology)
(Nephrology)
Bump it Up
(Pregnancy)
(Pregnancy)
Desert Diagnosis
(Arizona)
(Arizona)
100
This first-line treatment for Primary Biliary Cholangitis improves transplant-free survival by decreasing bile acid toxicity.
What is ursodeoxycholic acid?
100
A patient with HIV is found to have a CD4 count of 180. According to guidelines, prophylaxis should be initiated to prevent infection with this opportunistic organism.
What is Pneumocystis jirovecii pneumonia (PJP) with trimethoprim-sulfamethoxazole (Bactrim)?
100
Which type of kidney stone is classically associated with this appearance?
What is Sturvite Stone?
100
A 35-year-old woman at 33 weeks gestation presents with right upper quadrant pain, nausea, and a severe headache. Her blood pressure is 162/108. Labs show elevated liver enzymes, thrombocytopenia, anemia with schistocytes, and high LDH. What is the most likely diagnosis?
What is HELLP syndrome?
100
This natural wonder in northern Arizona is one of the Seven Natural Wonders of the World.
What is the grand canyon?
200
In addition to antibiotics, this therapy should be administered to an 80 kg patient with spontaneous bacterial peritonitis (SBP) to reduce the risk of renal failure—given as 120 grams on day 1 and 80 grams on day 2.
What is IV albumin?
200
A 32-year-old man presents with cough, night sweats, and weight loss. A chest X-ray shows cavitary lesions in the upper lobes. This is the best initial test to confirm active tuberculosis.
What are acid-fast bacilli (AFB) smears and cultures every 8 hours and nucleic acid amplification testing (NAAT)?
200
A 30-year-old man with type 1 diabetes presents with vomiting, diarrhea, and abdominal pain. His labs reveal:
Na⁺: 140 | Cl⁻: 106 | HCO₃⁻: 10
ABG: pH 7.18 | pCO₂: 24 mmHg | HCO₃⁻: 10 mEq/L
What two acid-base disorders are present?
What are high anion gap metabolic acidosis (HAGMA) and normal anion gap metabolic acidosis (NAGMA)?
200
A 32-year-old woman with chronic hypertension presents for prenatal care at 12 weeks’ gestation. What medication should be initiated to reduce her risk of developing preeclampsia?
What is low-dose aspirin?
200
This Arizona landmark is a red-rock cathedral and vortex hotspot, popular with hikers and spiritual seekers alike.
What is Sedona?
300
This blood test is highly specific and sensitive for diagnosing autoimmune pancreatitis.
What is serum IgG4?
300
A 45-year-old man from Italy with a history of immune-active hepatitis B who completed treatment a year ago now presents with elevated transaminases. His hepatitis B viral load remains undetectable. This test should be ordered next to evaluate persistent liver inflammation.
What is hepatitis D virus testing?
300
A 48-year-old woman with a history of dry mouth and dry eyes presents with fatigue and recurrent kidney stones. Labs reveal:
Na⁺: 140 | Cl⁻: 114 | HCO₃⁻: 13 | K⁺: 3.0
ABG pH: 7.31 | Urine Na⁺: 40 | Urine K⁺: 25 | Urine Cl⁻: 30 | Urine pH: 6.5
What is the most likely diagnosis?
What is Type 1 (distal) renal tubular acidosis (RTA)?
300
A 29-year-old woman at 30 weeks gestation presents with severe pruritus on her palms and soles without rash. Labs show elevated transaminases and normal bilirubin. She had similar symptoms in a prior pregnancy. What is the most appropriate treatment?
What is ursodeoxycholic acid?
300
This Native American tribe’s reservation in northeastern Arizona is the largest in the U.S. by land area.
Who are the Navajo?
400
Name three extraintestinal manifestations of inflammatory bowel disease (IBD).
What are aphthous ulcers, arthritis, and uveitis? (Other acceptable answers include sacroiliitis, erythema nodosum, pyoderma gangrenosum, primary sclerosing cholangitis, nephrolithiasis, anemia, osteoporosis, and pigmented gallstones.)
400
A 35-year-old hiker from Connecticut presents with facial nerve palsy and flu-like symptoms two weeks after a camping trip. He denies rash and didn’t notice a tick bite. This is the most appropriate initial test to support a diagnosis of early disseminated Lyme disease.
What is a two-tiered test with ELISA followed by Western blot?
400
A 40-year-old man with bipolar disorder started on a new medication he cannot recall presents with polyuria and polydipsia. Labs show serum sodium of 148 and urine osmolality of 280. Water deprivation testing fails to concentrate the urine, and desmopressin has no effect. This medication is the treatment of choice.
What is amiloride?
400
A 25-year-old woman with a history of kidney transplant is planning pregnancy. Her medications include nifedipine, labetalol, tacrolimus, prednisone, and mycophenolate mofetil. Labs and vitals are normal. Which medication should be discontinued before conception?
What is mycophenolate mofetil?
400
This Arizona native was the first woman to serve as a U.S. Supreme Court Justice.
Who is Sandra Day O’Connor?
500
A 58-year-old man with cirrhosis and ascites presents with progressive dyspnea and hypoxemia that worsens when sitting upright and improves when lying flat. Physical exam reveals digital clubbing and an oxygen saturation of 88% on room air when upright. This is the best next step to confirm the suspected diagnosis.
What is contrast-enhanced echocardiography (bubble study) for hepatopulmonary syndrome?
500
A 60-year-old man from Connecticut presents with fever, chills, and malaise. Labs show leukopenia and thrombocytopenia. Peripheral smear reveals intracytoplasmic morulae in neutrophils. Given the likely vector, these other tick-borne infections should also be considered.
What are Lyme disease and Babesiosis?
500
A 55-year-old man presents with lower extremity swelling, fatigue, and arthralgias. Urinalysis shows 3+ protein, 2+ blood, red cell casts, and a 24-hour urine protein of 3.5 g. Labs reveal a creatinine of 1.8 mg/dL (baseline 1.0), low C4, low-normal C3, positive cryoglobulins, and negative ANA and ANCA. Kidney biopsy shows membranoproliferative glomerulonephritis with subendothelial immune complex deposits and double-contour basement membranes. What is the most appropriate next step in identifying the underlying cause?
What is testing for hepatitis C virus?
500
A 28-year-old woman with a mechanical aortic valve on warfarin presents for preconception counseling. Her INR is therapeutic and she has no cardiac symptoms. What is the most appropriate anticoagulation strategy during pregnancy?
What is to continue warfarin except for switching to low-molecular-weight heparin between weeks 6 and 12?
500
Located near the town of Oracle, this massive sealed scientific structure was designed to simulate Earth’s environment and was once used for long-term isolation experiments.
What is Biosphere 2?