CV/Heme-Onc
A 45-year-old male presents with new onset exertional chest pain. EKG shows inferolateral ST depressions. Troponin is elevated. Initial management should include dual antiplatelet therapy, an ACE inhibitor, a beta-blocker, and a high-intensity statin to treat this acute coronary syndrome.
What is NSTEMI (Non-ST Elevation Myocardial Infarction)?
A 30-year-old female presents with recurrent episodes of abdominal pain, psychiatric symptoms, and dark urine after standing. Elevated urinary porphobilinogen and delta-aminolevulinic acid are diagnostic.
What is Acute Intermittent Porphyria (AIP)?
A patient with progressive dyspnea and clubbing and bibasilar crackles on exam has a chest CT showing traction bronchiectasis and honeycombing. PFTs show reduced FVC and TLC with a normal FEV1/FVC ratio. This is the most likely diagnosis.
What is Idiopathic Pulmonary Fibrosis (IPF)?
A patient with recent pituitary surgery for acromegaly develops polyuria and polydipsia. Urine specific gravity is low. Serum sodium is 148 mEq/L. This hormonal deficiency is the most likely cause.
What is ADH (antidiuretic hormone) deficiency, leading to central diabetes insipidus?
This specific form of nephritic syndrome is characterized by a "wire loop" appearance on kidney biopsy and is commonly associated with Systemic Lupus Erythematosus.
What is Diffuse Proliferative Glomerulonephritis (Class IV Lupus Nephritis)?
A 68-year-old female with breast cancer metastasizing to bone presents with confusion and constipation. Her serum calcium is 14.2 mg/dL. The immediate treatment for this life-threatening electrolyte derangement is this intravenous fluid.
What is normal saline (0.9% NaCl) infusion? (Followed by bisphosphonates if resistant).
A patient with a history of recurrent DVTs and fetal losses is found to have prolonged aPTT that does not correct with mixing studies but shows no bleeding tendency. This autoimmune condition should be further investigated.
What is Antiphospholipid Syndrome
A patient on mechanical ventilation is found to have plateau pressures significantly higher than peak pressures, suggesting an increase in this specific resistant parameter.
What is airway resistance (indicating bronchospasm or mucous plugging)? (Increased plateau pressure suggests decreased compliance).
A 30-year-old female with a history of generalized anxiety disorder presents with muscle weakness, weight gain, purple striae, and central obesity. Her morning cortisol is elevated and not suppressed by a low-dose dexamethasone suppression test. What is the next diagnostic step to localize the source of her hypercortisolism?
What is a high-dose dexamethasone suppression test (if ACTH is elevated) or imaging of the adrenal glands (if ACTH is suppressed)?
A patient with macroscopic hematuria following an upper respiratory tract infection, along with normal complement levels, suggests this common form of glomerulonephritis.
What is IgA Nephropathy (Berger's Disease)?
A patient presents with acute shortness of breath and new-onset atrial fibrillation with rapid ventricular response. Echo shows severe mitral regurgitation with flail leaflet. This immediate intervention is often considered in hemodynamically unstable patients to stabilize the rhythm and improve hemodynamic status.
What is electrical cardioversion?
A 45-year-old immigrant from Southeast Asia presents with progressive muscle weakness, paresthesias, and macrocytic anemia. Diet history reveals exclusive white rice consumption. What vitamin deficiency is the most likely cause?
What is Thiamine (B1) deficiency, leading to Wernicke-Korsakoff or Beriberi
A former smoker presents with chronic cough, dyspnea, and recurrent exacerbations. Chest CT shows centrilobular emphysema. What is the most appropriate pharmacological management for symptomatic relief and reduction of exacerbations?
What are long-acting bronchodilators (LABA/LAMA)?
A patient with Type 1 diabetes presents with nausea, vomiting, abdominal pain, and an anion gap metabolic acidosis. Glucose is 280 mg/dL, and urine ketones are strongly positive. What is the most critical initial management step besides insulin?
What is aggressive rehydration with intravenous fluids (e.g., normal saline)?
The use of NSAIDs in a patient with pre-existing renal insufficiency can lead to acute kidney injury due to their effect on this key renal physiological process.
What is afferent arteriolar vasoconstriction (leading to decreased GFR)?
A 35-year-old female presents with fatigue, easy bruising, and pancytopenia. Bone marrow biopsy reveals predominantly myeloblasts with Auer rods, staining positive for MPO. What specific cytogenetic abnormality, associated with a favorable prognosis, should be investigated?
What is t(15;17) (PML-RARa fusion gene), characteristic of Acute Promyelocytic Leukemia (APL)?
A patient presents with fatigue, pruritus, hepatomegaly, and hyperpigmentation ("bronze diabetes"). Ferritin is markedly elevated, and liver biopsy shows increased iron deposition. This genetic disorder is the most likely diagnosis.
What is hereditary hemochromatosis
A patient develops severe sepsis with refractory hypotension despite adequate fluid resuscitation. This vasopressor is generally considered first-line due to its potent alpha-1 and moderate beta-1 agonism.
What is norepinephrine (Levophed)?
A 60-year-old man presents with progressive memory loss, gait disturbance, and urinary incontinence. MRI shows ventriculomegaly disproportionate to sulcal atrophy. What is the potential reversible cause and its treatment?
What is normal pressure hydrocephalus (NPH), treated with ventriculoperitoneal shunting?
This diuretic class is known to cause hypercalcemia and hyponatremia, and should be used with caution in patients with gout due to its hyperuricemic effect.
What are Thiazide diuretics?
A patient post-MI develops acute onset shortness of breath, hypotension, and new holosystolic murmur heard best at the apex. Echocardiogram reveals an eccentric jet of mitral regurgitation. This specific anatomical complication is the most likely cause.
What is papillary muscle rupture?
A patient presents with episodic hypertension, palpitations, and sweating. 24-hour urine metanephrines are vastly elevated. This surgically resectable tumor of the adrenal medulla is the cause.
What is a pheochromocytoma?
A cirrhotic patient presents with new-onset shortness of breath, platypnea, and orthodeoxia. Echocardiogram shows right-to-left shunting. This lung complication of liver disease is characterized by intrapulmonary vascular dilations.
What is hepatopulmonary syndrome?
A patient presents with acute onset diplopia, ptosis, and dysphagia, worsened with repeated effort. There is no sensory loss. Edrophonium test is positive. This autoimmune condition targeting post-synaptic acetylcholine receptors is the most likely diagnosis.
What is Myasthenia Gravis?
A patient with recurrent episodes of acute, flank pain, hematuria, and a family history of kidney disease should be screened for this genetic disorder causing renal cysts.
What is Autosomal Dominant Polycystic Kidney Disease (ADPKD)?