Heart of Hearts
Live Er Die
Guns, Germs & Meals
Kidney Beans
We Get Sick Too
100
In 2025, the AHA updated their guidelines to start BP medication in patients with stage 1 HTN (BP > 130/80) if they have a PREVENT risk score of this.
BP meds are recommended for patients with BP > 130/80 AND cardiovascular disease OR a PREVENT risk score of > 7.5%
PREVENT score adds BMI and GFR to the ASCVD risk score; Urine alb/cr, A1C and zip code are optional
100
In 2020, USPSTF updated HCV screening guidelines. HCV recommends screening in this group.
Since Hep C has tripled since 2010, the USPSTF recommends screening for HCV infection at least once in adults ages 18 to 79.
IV heroin use increased from 1995 to 2016 due to the opioid epidemic, now declining due to the Turn the Tide Campaign.
100
Since 2019, this is the number one cause of pediatric death in the US
Firearm injury
100
Know your vowels. These are the five indications for hemodialysis.
A: acidosis
E: electolyte disturbance (severely high K or phos)
I: ingestion (salicylates, lithium, etc)
O: overload
U: uremia (BUN > 100, uremic pericarditis/encephalopthy)
100
KC has this lifelong condition which was recently confirmed with a device scrolling down her back. Later, she had a Cobb salad for lunch.
Scoliosis: use scoliometer to measure Angle of Trunk Rotation (ATR). If > 5 degrees, order scoliosis survey. A Cobb angle of > 10 degrees is a diagnosis of scoliosis. 35 degrees or greater warrants an ortho spine referral.
200
On November 10, 2025, the FDA started removing black box warnings from these products. It's still important to assess risks and have shared decision making when prescribing them.
HRT: Although the black box warnings for stroke and CV risk are being changed, physicians should assess ASCVD risk, breast cancer risk, contraindications, and uterine status before prescribing estrogen and progesterone products in postmenopausal women.
200
When LFTs are mildly elevated (< 5x ULN), we should consider these tests for a comprehensive evaluation of liver disease.
Work up for MASLD: CBC, ferritin, hep panel, RUQ sono
MASLD: ALT:AST > 1
200
In October 2025, the American Academy of Otolaryngology updated their guidelines to treat bacterial sinusitis. They recommend antibiotics if symptoms last longer than this duration of time.
14 days. They recommend Amoxicillin or Augmentin as first line medication.
200
A patient with UI has persistent dry mouth on Trospium and Enablex. She has the same effects with Vesicare and Oxybutynin. This class of medication is an alternative to anticholinergics but it's myr expensive.
Beta 3 agonists (Myrbetriq, Gemtesa) --> Botox injections --> posterior tibial nerve stimulation
All patients with UI should try Kegel exercises, scheduled voiding, pelvic floor PT; postmenopausal patients with vaginal atrophy can try Replens/Estrace
200
CWIV used this as first line treatment to clear his namesaked lesions as a teenager.
OTC: salicyclic acid or adapalene (Diferin)
Rx: tretinoin
300
In November 2025, the AHA discussed a study about the risks of this supplement on heart disease. Reading the whole thing will definitely put you to sleep.
Melatonin: Study was done on 130,000 adults with insomnia. Adults were from the UK and the US. The study found patients that used melatonin daily for one year or more had a 90% increased chance of heart failure over 5 years. Problems with the study: non-users were defined as patients who didn't have a rx for melatonin. In the US, melatonin is OTC.
300
In Oct 2023, AGA updated MASLD screening guidelines: Check LFTs once a year to screen for MASLD in these populations
Patients with one or more of the following: overweight, obese, diabetes, HTN, HLD
300
In 2024, this updated vaccine promised to prevent this gnarly respiratory disease. All 21 strains of it.
Prevnar 21
The first pneumonia vaccine was PPSV 14 in 1977. Since it was a polysaccharide vaccine, immunity only lasted 5 years. Prevnar should last lifelong since it's a conjugated vaccine.
Pediatric PNA deaths have reduced by 50% since 1990.
300
These are indications for nephrology referral:
Electrolyte disturbance, GFR < 30, rapid decline of GFR, anemia of CKD (Hb < 10), macroalbuminuria, RBC casts
300
TDHKN had this small pouch which was discovered after Xe swallowed an alkaline earth metal.
Zenker diverticulum - seen on barium (Xe6s2) swallow
The condensed electron configuration for Barium is: Xe6s2
400
The 2023 AHA PREVENT Score calculator can be used to stratify risk in ASCVD and heart failure patients in this age range.
PREVENT SCORE can be use in patients 30-79 without known CVD.
400
In 2022, ACIP recommended universal vaccination of hepatitis B in this age group if they hadn't received the vaccine previously
Since hepatitis B has increased by 114% since 2006, ACIP recommends universal hep B vaccination in the 19-59 yo age group
400
In 2024, we started encouraging our at-risk patients to RSVP for one of these three products to prevent SOB, wheezing and even hospitalization
Beyfortus; monoclonal Y for first 8 months of life in RSV season
Abrysvo: pregnancy 32-36 weeks or high risk patients > 18
Arexvy: high risk patients 50-74 yo or all patients > 75
400
In poker, 4 of these is a good hand. In CKD, it’s the mainstay of treatment. In ARF, you might want to stop them.
ACEs/ARBs
400
BMW couldn't help but gesticulate when she found out she had this sweet condition. Risk factors include: age > 35, BMI > 30, non-white race, family history, PCOS
Gestational Diabetes
Other risk factors: previous baby over 4000g (> 9 lbs), previous h/o GDM
500
In 2021, the ACC/AHA identified this blood test as an independent marker for ASCVD. In 2023, they recommended checking it one time in patients with elevated cardiac risk.
Lp(a) 
500
If a patient is found to have MASLD on US, fibrosis screening should be done by this non-invasive test
FIB-4 (age, AST, ALT, platelets) with reflex to ELF or a liver fibrosis panel
If FIB-4 is < 1.3 without risk factors --> repeat in 3 years
If FIB-4 is < 1.3 and pt has DM or 2 RFs --> repeat in 1-2 years
If FIB-4 is > 2.67 --> refer to GI
500
74% of the US population is overweight or obese.
GS is a 38 yo M. He is 6’1 and 400 lbs. How much weight will he lose with Wegovy vs Zepbound vs gastric sleeve?
BMI: 52, IBW: 191 lbs, Excess body weight: 209 lbs
Wegovy: 40 – 60 lbs
Zepbound: 60 – 80 lbs
Gastric Sleeve: 105 lbs
500
You check the PSA on a 60 yo patient who's being treated for BPH with Flomax and Finasteride. He's been on this treatment for over a year. A PSA above this number is considered abnormal.
2 ng/mL
500
Football was the sunshine of JP's life until he ripped apart his genicular moon. This test has the highest positive predictive value for JP's injury.
Meniscus (lunar crescent) tear
Thessaly test: 81% positive predictive value in meniscal tear
McMurray test: 66% positive predictive value