Cardiac
Calculate the following patient’s ChADs2-VASc score.
A 75-year-old male with a history of TIIDM, HTN, PAD, HFrEF presents to the emergency room with 45 minutes of palpitations. EKG reveals an irregularly irregular rhythm. The patient is hemodynamically stable.
What are the implications for long-term management?
Patient’s ChADs2-VASc is 6, and they are at a very high risk of stroke in the setting of Afib. Anticoagulation should begin with a DOAC (i.e. apixaban).
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What is the diagnosis, and what is a common cause?
RLL pneumonia, commonly caused by aspiration
On physical exam, a patient is able to lift their leg against gravity, but you can easily push their leg back to the exam table. How would you rate their strength in your note?
3/5
0: No visible or palpable muscle contraction
1: Flicker or trace of contraction, but no movement of the joint
2: Active movement with gravity eliminated
3: Active movement against gravity but not against resistance
4: Active movement against some resistance, but less than normal
5: Normal strength, full movement against gravity and full resistance
A 26 yo M with PMH AUD presents with melena and hematemesis. What diagnosis are we most concerned about? What are the next steps in workup and treatment?
Variceal bleed
They will need an EGD. If active bleeding we would start octreotide. If no active bleed we would start with BB for prophylaxis.
Name three adverse side effects of SGLT2 inhibitors?
Euglycemic DKA, necrotizing fasciitis, GU infections, dehydration, amputation (canagliflozin), hypoglycemia, AKI
What is the following rhythm?
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Aflutter with 2:1 block
What would medical management be for a COPD patient with GOLDs criteria stage B?
LAMA + LABA
An 86 yo F with PMH OA, DM2, HTN, and anemia presents with gait abnormalities. On exam you note wide-based gait, decreased proprioception and vibratory sense, and diminished patellar reflexes. You also note the following physical exam finding:
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The remainder of her neuro exam is normal. What is the likely diagnosis?
Neurosyphilis (Argyll Robertson pupils)
A 31-year-old patient presents with ten days of watery, non-bloody diarrhea. She went camping two weeks ago and went swimming in a river. Provided testing confirms the most likely diagnosis, what is the first-line medication she should be given?
Metronidazole (presumed Giardia)
A 62 yo M with PMH HTN, HLD, COPD, OA, and BPH living in the UES of Manhattan develops cough and diarrhea. Labs show hyponatremia to 122. You suspect Legionnaires. What is the gold standard diagnostic test?
Sputum culture
A 68-year-old patient with PMH of HTN, asthma, and PAD is diagnosed with HFrEF and severe AKI in the hospital. The decision is made to start GDMT while in the hospital. Which GDMT medication should be initially avoided, and why?
ACE’s/ARB’s/ARNI’s should be avoided due to efferent arteriole constriction, which can reduce GFR and worsen AKI.
What are the history risk factors for a patient with cough that would make us suspect TB? (Bonus- Where in the US is the only place that TB is still endemic?)
Hx of incarceration, housing instability, refugee status, nursing homes, HIV status
Alaska -- specifically the Seward peninsula and St Lawrence island is the only area in the US where TB is still endemic
A 78 yo F with PMH HTN, DM2, HLD, and CAD is brought in by her granddaughter for sudden weakness and sensory loss in her right face and arm, right-sided vision loss, and difficulty speaking. A stroke code is called in the ED and demonstrates an ischemic infarct. Where is the lesion?
Left MCA
A 55-year-old man with ETOH-related cirrhosis presents with massive hematemesis. Endoscopy reveals large esophageal varices with active bleeding. After band ligation and octreotide, bleeding is controlled. On hospital day 3, he develops fever, confusion, and a creatinine rising from 1.0 to 2.8. What is the most likely diagnosis?
Hepatorenal syndrome
What prophylaxis should a patient with a with a CD4 count less than 100 be on?
TMP SMX for PJP and Toxoplasmosis prophylaxis
A 34 yo M with no PMH presents with sudden onset palpitations and dizziness. Below is his EKG:
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What is the diagnosis? What drug should you absolutely AVOID giving?
Wolff Parkinson White Syndrome
Avoid digoxin (shortens refractory period)
What are the 5 groups of pulmonary HTN causes? What is the diagnostic test for PHTN?
RHC is the diagnostic test
According to the 2026 AHA/ASA guidelines, what are the standard and extended windows for tPA in acute ischemic stroke with disabling deficits?
Standard window: 4.5-hour
Extended window: "Wake-up" strokes or 4.5–9 hours from onset using advanced perfusion imaging criteria
A patient with cirrhosis undergoes diagnostic paracentesis. The serum-ascites albumin gradient (SAAG) is 1.8 g/dL, and the ascitic fluid absolute neutrophil count is 280 cells/mm³. What is the diagnosis and specific treatment you should give?
Spontaneous bacterial peritonitis -> ceftriaxone
A 54 yo F with PMH HTN, CKD3b, HFrEF, and HLD is admitted for CHF exacerbation. On day 3 of admission, her morning potassium level is elevated to 5.9 mmol/L. You review her med list:
- Lisinopril 20 mg daily
- Furosemide 80 mg IV BID
- Spironolactone 25 mg daily
- Hydrochlorothiazide 100 mg daily
- Empagliflozin 10 mg daily
- Carvedilol 3.125 mg BID
Which medication(s) may be contributing to hyperkalemia?
Lisinopril and spironolactone (high), carvedilol (low)
A 27-year-old patient presents to the emergency department with severe, crushing, left-sided chest pain. His friends say that they were at a party, when he suddenly began clutching his chest and fell to the floor, yelling in pain. Vitals are notable for HR 115 and BP 150/105. Exam reveals erythematous nares. EKG shows T wave inversions in the anterior leads. The patient is given aspirin, nitrates, metoprolol, and atorvastatin. 10 minutes later, the patient feels that their chest pain is worse. Repeat vitals show HR 120, BP 190/130. T wave inversions have spread to the lateral leads. What is the most likely cause of the patient’s worsening symptoms?
Likely iatrogenic due to the B-blocker administration. This patient likely has cocaine-induced MI. In this setting, B-blocker is absolutely contraindicated due to the resulting unopposed alpha-adrenergic stimulation, which causes vasoconstriction and worsens BP/MI symptoms.
A 62-year-old patient with a history of HFrEF has a unilateral pleural effusion and leukocytosis (WBC: 14K). What are the categories of pleural effusion, and what specific diagnostic tests/criteria can be used to characterize this patient’s effusion?
Transudative vs. Exudative
Characterize with pleural fluid/serum LDH or pleural/serum protein using Light’s criteria:
Pleural fluid LDH: Serum fluid LDH > 0.6 (exudative)
Pleural fluid protein: Serum fluid protein > 0.5 (transudative)
A patient presents with ipsilateral Horner syndrome, ipsilateral cerebellar ataxia, ipsilateral loss of pain and temperature on the face, and contralateral loss of pain and temperature on the body. Which syndrome is this?
Hint: results from the occlusion of the posterior inferior cerebellar artery (or vertebral artery).
Lateral medullary (Wallenburg) syndrome
A 35-year-old man presents with recurrent episodes of right upper quadrant pain, jaundice, and fever. Labs reveal elevated alkaline phosphatase and positive p-ANCA. ERCP demonstrates multifocal strictures and dilations of intrahepatic and extrahepatic bile ducts. What is the diagnosis, and what other GI pathology should you be concerned about?
PSC (primary sclerosing cholangitis), associated with ulcerative colitis
For which patients is finerenone indicated?
Patients with DM2 and CKD with albuminuria