FUF

My Achy Breaky Heart

100

After PCI with DES:

How long is DAPT recommended for?

Chronic CAD: 6 to 12 months DAPT -> Monotherapy

ACS: 12 months -> Monotherapy

*Shorter Duration for High Risk of Bleed*

        *PRECISE-DAPT Score: Risk of Bleed

*DAPT Score: Prolonged DAPT > 12 months

200

Wide Complex Tachycardia

This condition is defined as at least 3 episodes of VT or VF within 24 hours

VT/VF Storm

300

In ACS:

Name at least 3 contraindications to early BB use...

1. 1st deg AVB (PR >0.24) 

1a. Unpaced 2nd or 3rd Degree AVB

2. Active Bronchospasm

3. Hypotension +/- Shock (including AMI-CS)

4. Severe Bradycardia 

5. ACS due to Cocaine

7. Acute Heart Failure 

400

After ACS s/p reperfusion:

Pt's with this TTE finding do not benefit from long term Beta Blocker therapy.

LVEF > or = 50%. No difference in new HF, All cause death, recurrent MI

Uncertainty remains in optimum duration of BB 

500

Name at least 3 EKG Features of Ventricular Arrythmia

1. NW Axis (-90 to +180)

2. AV dissociation

3. Wide QRS (> 140)

4. Fusion or Capture Beats 

5. Loss of RS morphology in precordials

6. RS duration > 100ms (2.5 small boxes)

7. Various QRS Morphology criteria

The Clot Thickens

100

In Acute PE, give at least 3 features, or lack thereof, that are consistent with a safe outpatient treatment course?

1. Low Risk Score (PESI, Hestia, BOVA)

2. Negative cardiac biomarkers

3. Negative RV strain 

4. Does not need supplemental oxygen

200

In PE, what constitutes "Hypotension" or Hemodynamic Instability (Give at least 2 parameters)

SBP < 90mmHg or drop >39 mmHg for at least 15 minutes 

SBP < 90mmHg + End organ hypoperfusion

Requirement for Vasopressors to keep SBP > 90

*Watch for Normotensive Shock*

300

In Ischemic Stroke, Individuals can receive thrombolytics up to 9 hours if THIS (type) imaging shows salvageable tissue

AHA 2026 Stoke GL 

Individuals with DWI-FLAIR imaging showing mismatch (i.e. salvagable penumbra)

"absence of a clearly visible, or marked, hyperintense signal in the same region on FLAIR as DWI"

Exclusions: NIH >25, Contraindications, > 1/3 MCA

400

In Superfical Vein Thrombosis

Name at least 2 findings that would warrant anticoagulation

1. Thrombus > or = 5 cm in length

2.  Persistent or worsening symptoms despite conservative therapy

3. Clot within 3cm of Deep Vein

4. Involvement of Greater Saphenous

5. Other ongoing risk factors for clotting

**Differences between PPX and Tx AC**

500

In Anti-Phospholipid Syndrome

1. Describe the Clinical Criteria

2. aPL labs and Timing

2023 ACR/EULAR Classification Criteria

1. Thrombosis or Pregnancy Morbidity

- Clot in Artery or Vein, 3 abortions before 10w or 1 after 10w, or premature birth due to pre-E/E or placental insufficiency

1. LA, aCL, anti-B2GPI

- > 99th percentile

2. Labs at least 12 weeks apart

Bug Out

100

Extended infusions is useful for antibiotics that exhibit ________ dependent MOA

Time Dependent (-cidal or static)

200

Assuming an extended infusion strategy, when would you choose 4.5g over 3.375g, every 8 hours?

1. Pseudomonas aeruginosa

2. Other nosicomial PNA

3. Febrile Neutropenia (NCCN rec q6 hours, std infusion rate?)

4. Hyperfiltration (N. ICU, Sepsis, Trauma, Preg)

300

What organism can fulfill (IE) mDUKE Major Clinical criteria from a single blood culture?

1. Coxeilla burnetii

Other "Typical Organisms" include

Stapylococci, Strepococci, Enterococci, HACEK

(Hemophilus, Aggregatibacter, Cardiobactium hominis, Eikenella, Kingella)

400

Jarisch-Herxheimer Reaction is classically associated with treatment of these types of organisms

Jarisch-Herxheimer: acute, self-limited febrile reaction, usually within 24 hours after starting therapy for a spirochetal infection.

T. pallidum, Borrelia spp, Leptospira

500

What Klebseilla spp produces AMP-C resistance, and name 2 ABX that can be used to treat it

1. K. aerogenes, formerly known as Enterobacter aerogenes

2. AMP-C organisms can be treated by Cefepime, Avycaz, or carbapenems

Bean Bros

100

CKD

Name the GFR thresholds for CKD3, CKD4, CKD5, and ESRD

CKD3a: 45 to 59

CKD3b: 30 to 44

CKD4: 15 to 29

CKD5: <15

ESRD: RRT or need for transplant (CKD5 + RRT)

200

This eGFR is the minimum need to START an SGLT2i, such as Jardiance

eGFR > or = 20 is needed to start SGLT2i

It is reasonable to continue this medication if eGFR drops < 20

300

Constellation of HLD, profound Edema, heavy proteinuria, and a renal vein thrombosis should raise suspicion of what disease process?

Classically: Membranous Nephropathy, anti-PLA2R

Also Consider: FSGS and Class V Lupus Nephritis

400

_______ is associated with hepatic cysts and intracranial Berry aneurysms and has BP Goal of _______.

Autosomal Dominant Polycystic Kidney Disease

BP Goal < 110/75 for ages <50

If 50 or >, or CKD3 or worse, SBP goal 120 or less

500

How does this condition present and what is/are the acute treatment(s)??

Linear Immunoflouresence of anti-GBM disease

Presentation: Most commonly with RPGN (macrohematuria, proteinuria, RBC casts etc).

Pulm-Renal: Small % with have capilaritis with hemoptysis

Immediate Tx is PLEX within 24H plus immunosuppression with steroids and cyclophosphomide

Here be Dragons

100

Name this ECMO "Sign" and describe its physiology and what pt will look like if you do nothing (aside from dead)

Harlequin Sign of VA ECMO

Evidence of cardiac recovery -> DANGEROUS!

200

ABG: pH 7.20|pCO2 20|paO2 90| SpO2 95%

BMP: HCO3 = 12, AGAP 24

What is the secondary acid base disturbance

Compensation by Winter's Formula

  PaCO2 = 1.5 * (HCO3) + 8 +-2 

Expected paCO2 = 24-28, actual 20

***Concurrent Respiratory Alkalosis

300

Described the differences between AVRT vs AVNRT in terms of conduction pathway

400

This antibody is associated with Immune Mediated Necrotizing Myopathy

500

22 yo M with palpitations, EKG, and FH of SCD

What "sign" is present and what "syndrome" does he have?

Brugada Syndrome = EKG + Symptoms

Brugada Sign = EKG only