The Great Suppression
Poison Pearls
U Thought
That's CAP
Diagnose that Diva
100
Name 3 indications for long term PPI use.
What are
100
This lab finding differentiates CCB overdose from BB overdose.
What is hyperglycemia?
100
This is the expected FEV1, FVC, FEV/FVC, TLC, and DLCO for a patient with ILD.
What is a restrictive pattern (low FEV, low FVC, low TLC, preserved FEV/FVC ratio, low DLCO).
100
Initial empiric treatment for MRSA PNA can include these two types of antibiotics to cover MRSA.
What are vancomycin or linezolid.
Not dapto! Surfactant will impair its ability to work in the lungs.
100
Selena Gomez underwent a kidney transplant in 2017 due to this autoimmune disease. A pre-transplant renal biopsy showed wire-loop lesions with subendothelial deposits.
What is systemic lupus erythematosus (SLE)?
200
Name 2 vitamins or minerals that have affected absorption due to PPIs.
What are magnesium, calcium, B12, and iron?
200
What are 5 causes of AV block.
What are
Degenerative
Age-related conduction system fibrosis (Lenègre-Lev disease)
Ischemic
Acute MI (inferior → nodal block; anterior → infranodal block)
Chronic ischemic cardiomyopathy
Infiltrative/inflammatory
Sarcoidosis
Amyloidosis
Infectious
Lyme carditis
Viral myocarditis
Bacterial endocarditis (with perivalvular abscess)
Metabolic/endocrine
Hyperkalemia
Severe hypothyroidism
Congenital/genetic
Congenital heart disease
Genetic mutations (SCN5A mutation)
Neonatal lupus
Medications/toxins
Beta blockers
Calcium channel blockers
Digoxin
Class I/III antiarrhythmics
200
Name the classic pattern of thyroid studies seen in euthyroid sick syndrome (T3, T4, TSH, rT3).
What is reduced T3 (earliest), reduced T4, reduced TSH, and increased rT3.
200
This zoonotic pneumonia is associated with livestock, parturient animals, and hepatitis.
What is Coxiella burnetii (Q fever)?
Incubation: 2–3 weeks
Most patients have:
- High fever
- Severe headache
- Myalgias
- Malaise
May develop:
1. Atypical pneumonia
- Dry cough
- Mild dyspnea
- Patchy infiltrates
- Often appears "less sick" than imaging suggests
2. Hepatitis
- Elevated AST/ALT
- Often minimal jaundice
- Can present as fever of unknown origin with hepatitis
200
Angelina Jolie underwent cancer risk-reducing surgery at 39 years old after testing positive for a germline mutation in this tumor suppressor gene involved in homologous recombination repair.
What is BRCA1?
Carriers face a 60%–72% lifetime breast cancer risk and 39%–58% lifetime ovarian cancer risk
BSO recommended at 35–40 years old
300
This is the duration of high-dose PPI recommended as continuous or intermittent therapy after successful endoscopic hemostatic therapy of a bleeding ulcer.
What is 3 days?
high dose is ≥80 mg daily
ACG recommendation with high quality evidence
300
Name all first line therapies for hemodynamically significant CCB overdose.
What are IV calcium, high-dose insulin, and vasopressor (norepi)
300
Aneurysm of this artery is associated with a third nerve palsy, manifesting as a dilated pupil and loss of accomodation early in the process, followed by ptosis and opthalmoplegia late in the process.
What is the posterior communicating artery?
300
DAILY DOUBLE: The choosing team only gets a chance to wager up to double points (Can either wager 0, 300 or 600. Wrong answer is negative points):
In suspected Pneumocystis jirovecii pneumonia, these two serum tests are commonly elevated—one reflects tissue injury, while the other detects fungal cell wall components.
What are LDH and (1→3)-β-D-glucan (Fungitell)?
- LDH: Elevated in about 70–90% of HIV-associated PJP, but you should never diagnose PJP based on LDH alone.
- Fungitell: Positive in roughly 9 out of 10 patients with PJP (≈91–96% sensitivity). A negative β-D-glucan makes PJP less likely, but it does not completely rule it out, especially in patients with a high pretest probability.
300
Kim Kardashian has this condition, in which overactive Th17 cells and cytokines IL-17 and TNF-α drive keratinocyte overgrowth, and which is complicated by a seronegative arthritis in about one-third of patients.
What is psoriasis?
400
DAILY DOUBLE
Strong CYP219 inhibitors, including this PPI, should be avoided in patients on clopidogrel.
What is omeprazole/esomeprazole?
Clopidogrel is a prodrug that requires conversion to its active form by CYP219 metabolism.
Pantoprazole is the better choice due to weaker CYP219 inhibition.
PPI therapy dos not affect the efficacy of ticagrelor or prasugrel.
Patients on DAPT with elevated risk, including those with PUD, prior GIB, H. pylori infection, or age >65, should be started on PPI therapy.
400
A 45-year-old presents with tinnitus, tachypnea, and diaphoresis. ABG shows pH 7.45, pCO₂ 20, HCO₃ 14. The is the acid-base disturbance, the likely toxin, and treatment.
What are mixed respiratory alkalosis and metabolic acidosis, salicylate (aspirin), and alkalinization (serum and urine: bicarb and acetazolamide)?
This mixed disturbance is often considered pathognomonic
400
A man develops painless blisters on the backs of his hands after sun exposure, he also has chronic hep C, this diagnosis should be suspected.
What is porphyria cutanea tarda?
400
This radiographic sign, characterized by peripheral ground-glass opacity surrounding a pulmonary nodule, is classically seen in invasive pulmonary aspergillosis.
What is the halo sign?
400
Celine Dion postponed her tour because of this rare autoimmune neurologic disorder, in which muscle stiffness and painful spasms are triggered by noise or emotional stress and are treated with diazepam and IVIG.
What is stiff person syndrome?
500
3 months after starting a PPI for UGIB, your patient presents with subjective fevers, malaise, and a new found AKI. This is what you would anticipate finding on the urinalysis.
What are WBCs and WBC casts +/- mild RBCs, proteinuria, or eosinophils (40%)
Classic triad of fever, skin rash, and eosinophilia is rarely present
Tx is discontinue offending agent and glucocorticoids
500
This is the immediate treatment for a 24-year-old is brought in obtunded after an unwitnessed ingestion; an amitriptyline pill bottle is found. Pupils are 7 mm, skin is dry and flushed, bladder is distended. HR 128 sinuswth a wide of QRS 168 ms. ABG pH 7.18. She has a witnessed generalized seizure that terminates in the ED.
What is sodium bicarbonate?
500
Name 3 dietary modifications to reduce the risk of the calcium based nephrolithiasis.
What are increase fluids (>2L), increase dietary Ca (supplement), decrease oxalate, increase citrate, decrease Na, decrease animal protein, increase potassium?
500
This pathogen causes pneumonia after exposure to birds, especially parrots.
What is Chlamydia psittaci?
C. psittaci accounts for approximately 1% of community-acquired pneumonia cases overall.
Clinical presentation: Ranges from asymptomatic infection to severe atypical pneumonia. Classic symptoms include high fever, dry cough, headache, and myalgia, often with elevated CRP and a characteristic pulse-temperature dissociation ( heart rate that is inappropriately low relative to the degree of fever)
Psittacosis is notoriously difficult to diagnose with conventional methods:
Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) is the most sensitive and rapid approach
500
Venus Williams stepped back from tennis in 2011 after being diagnosed with this autoimmune disease, which carries a roughly 15- to 20-fold increased risk of B-cell lymphoma.
What is Sjögren's disease?
MALT lymphoma predominates (~76% of cases), typically arising in salivary glands