Lupus? Is it Lupus??
Food is love, food is life
I want TB the very best, like no one ever was
Take a STEP back...
Super/Olympic Sized Fun!
100
Name 3 specific labs you want to monitor every 1-3 months while treating lupus nephritis
UA, renal function, dsDNA, C3/C4
100
Which plant-based milk is closest in nutrition to cow's milk?
Soy
100
A 72 year old man is evaluated for decreased responsiveness after spending a day at the zoo in 102 F weather. Only PMH is HTN on thiazide and ACEi.
On exam, his temp is 104.9 F, BP 97/54, HR 117, RR 22, SpO2 99% on RA. He is somnolent with skin that is flushed, warm, and dry. Rest of exam unremarkable other than tachycardia. Labs are pending. What is the best next step in management?
A. Tylenol | B. Dantrolene | C. Evaporative Cooling | D. Ice Water Immersion | E. Monitor Clinically
Evaporative Cooling!
This is nonexertional heat stroke (in the setting of extreme temperatures and volume depletion from diuretics).
Treatment is imperative as mortality is 60% without tx. Evaporative cooling (water mist and fans, +/- ice packs) is first line, noninvasive, and easiler performed. Antipyretics are not effective.
Ice water immersion may be necessary in young persons with exertional heat stroke when they remain severely symptomatic despite evaporative cooling, but not first line as it may be c/b hypothermia. It is contraindicated in older persons with NEHS as it is associated with increased mortality (risk of overcooling, CV strain, difficult to implement safely)
100
A patient comes in to your clinic with a wart on their face! What is the first line treatment?
Topical salicylic acid
Other areas can do excision, but this is often avoided on the face due to scarring
Other treatments include cryotherapy or laser treatment in general
100
The halftime show of the Super Bowl in 2004 between the New England Patriots and Carolina Panthers had one of the most infamous wardrome malfunctions of all time involving which 2 celebrities?
Janet Jackson and Justin Timberlake
200
Which class(es) of lupus nephritis are treated most aggressively?
200
2 of these nuts give you 100% of your daily selenium
Brazil nuts!
200
When is a patient able to be taken off of airborne precautions when treating a case of active TB?
- Symptoms improve (generally after ~2 weeks of therapy)
- Negative AFB samples x3 spaced 8 hours apart (one should be a morning sample)
200
What is the likely diagnosis in a patient with weight loss, tachycardia, anti-thyroid peroxidase antibodies, and a physical exam with a normal sized, nontender thyroid, low TSH, high free T4, and <5% radioactive iodine uptake?
Painless (silent) thyroiditis
200
Who was the American figure skater in the 90s who infamously planned an attack on their rival before a championship match?
Tonya Harding!
300
Name 2 biomarkers that are associated with active disease in lupus
Anti-dsDNA, C3/C4, ESR, Anti-C1q, anti-nucleosome
300
Which nut has the most potassium?
Pistachios!
300
What is the strongest risk factor of progression from latent to active TB?
Bonus: How much higher is the risk?
Development of AIDS, risk is 800 times higher (5-10% lifetime risk in immunocompetent patient vs 7-10% annual risk in untreated HIV)
Other things that increase risk include solid organ transplantation, silicosis, TNF-alpha blockers, chronic renal failure
300
What musculoskeletal patholgies are often associated with primary biliary cholangitis?
Osteoporosis and osteomalacia; etiology not entirely clear. Other complications include malabsorption and HCC
300
The reddit page r/Superbowl is no longer about football, what is it about now?
Owls! (Superb Owl)
400
Name 3 absolute contraindications and 1 relative contraindication to getting a renal biopsy in a patient you are concerned has lupus nephritis
Absolute: Bleeding diathesis, Uncontrolled Severe HTN, Active Renal/Perinephric infection, unsafe window
Relative: On AC/AP, solitary kidney, advanced CKD with small, echogenic kidneys
400
What hormone does exercise supress and what hormone does it increase in regards to hunger?
Supresses hunger hormone ghrelin, increases satiety hormone peptide YY
400
Your patient with difficult to control RA (improved only with her regimen of prednisone 20mg daily for the past several months) presents for follow-up of her PPD reading. The induration is 6mm. How do you interpret this?
Positive, immunosuppressed patients have lower threshold!
400
A 68 year-old woman is being evaluated for involuntary urine loss that occurs with coughing, sneezing, and laughing. No dysuria, urinary frequency, hemature, or nocturia, though does have vaginal dryness and dyspareunia. She performs pelvic floor muscle training QID. On PE, mild leakage of urine occurs while bearing down. BMI 22. What is the best next step in management?
Topical vaginal estrogen
1st line therapy is pelvic floor exercises, but seeing as she has failed that, topical vaginal estrogen is a reasonable second line option for postmenopausal women with stress incontinence (she has typical genitourinary postmenopausal symptoms with dryness, dyspareunia)
Weight loss would also be indicated if she was overweight.
400
Which US men and womens athlete have the most gold medals for the olympics of all time? (Name both)
Bonus: Which US athletes have the most gold medals of the winter olympics of all time?
Male: Michael Phelps (23 gold, 28 total)
Female: Katie Ledecky (9 gold, 14 total)
Bonus: Speedskaters Bonnie Blair and Eric Heiden have the most winter golds with 5 each
500
Best additional medication treatment (if any)?
Hydroxychloroquine and MMF
HCQ almost always indicated in SLE, but given he has signs of moderate to severe disease organ dysfunction (nephritis) you would start immunosuppressing treatment as well (MMF, cyclophosphamide)
500
Name 2 of the fruits/vegetables that were on the EWG's "Dirty Dozen" and 3 on the "Clean Fifteen" (AKA contain the most and least pesticide and herbicide residue)
500
What is the difference between traditional RIPE therapy and the alternative HPMZ therapy for susceptible pulmonary TB in regards to medications and timing?
Traditional RIPE is ~6 - 8 months (rifampin, isoniazid, pyrazinamide, ethambutol, B6)
HPMZ is shorter, ~4 months (rifapentine, isoniazid, moxifloxacin, pyrazinamide, B6)
No substitutions! (can't sub rifampin for rifapentine)
500
A patient presents with chronic exercise intolerance with myalgias, fatigue, painful cramps, and myoglobinuria). Which glycogen storage disease is the most likely diagnosis?
McArdle disease (Glycogen storage disease type 5)
500
What is the big scandal of the 2026 winter olympics in ski jumping?
Crotch gate!
