Avengers: EndOCardium
According to the 2025 ACC/AHA ACS guidelines, this oral P2Y₁₂ inhibitor is preferred over clopidogrel in patients with ACS undergoing PCI, unless contraindicated, because of its superior reduction in ischemic events.
What is prasugrel or ticagrelor? (Name at least one)
According to the 2022 Surviving Sepsis Campaign and pivotal ATHOS-3 trial, this synthetic vasopressor is indicated for patients with refractory septic or distributive shock despite conventional vasopressors, and has a unique mechanism compared with catecholamines. Name the drug and its mechanism of action.
What is Giapreza (angiotensin II) Mechanism: Directly activates angiotensin II
type-1 receptors → vasoconstriction → increased MAP
This class of medications is recommended by the 2024 EASL–EASD–EASO guidelines for patients with metabolic dysfunction–associated steatotic liver disease (MASLD) and type 2 diabetes to reduce liver-related outcomes.
What are SGLT2 inhibitors?
This chromosomal abnormality , t(9;22) is named after the city where it was first identified and is characteristic of chronic myeloid leukemia.
What is the Philadelphia chromosome?
I’m round and clear, worn to see far and near. What am I?
Glasses (or contact lenses)
According to the 2024 AHA/ACC multisociety guidelines, in symptomatic obstructive hypertrophic cardiomyopathy patients who remain severely symptomatic despite maximally tolerated beta-blockers or non-dihydropyridine calcium channel blockers, this novel pharmacologic class is now recommended before considering septal reduction therapies.
What are cardiac myosin inhibitors (e.g., mavacamten)?
The 2024 Society of Critical Care Medicine guidelines recommend this corticosteroid regimen (name and dose) for adult patients with septic shock.
What is a daily dose of less than 400 mg of hydrocortisone equivalent?
According to the 2022 ACG Clinical Guideline for Celiac Disease, in adults undergoing serologic testing for celiac disease, patients should be consuming ____ (dietary component) for at least ___ (duration) prior to testing to avoid false-negative results.
(need both)
Gluten
6 or more weeks
These criteria, developed in an Italian city, are used to select patients with hepatocellular carcinoma for liver transplantation.
What are the Milan criteria?
• Diagnosis can be made with contrast-enhanced CT or MRI showing typical HCC features.
• Biopsy is not required unless imaging is atypical or there’s diagnostic uncertainty.
• This minimizes bleeding risk and tumor seeding.
I go inside you but I’m not food. I tell the doc what’s wrong with you. What am I?
An endoscope
A patient presents with 2:1 AV block. You perform a vagal maneuver, and the block worsens (more non-conducted P waves). According to the 2018 ACC/AHA/HRS bradycardia guideline, what is the most likely diagnosis AND the appropriate next step?
What is Mobitz I (Wenckebach, AV nodal block), and observation unless the patient is symptomatic?
According to the 2023 ATS/ESICM/SCCM guidelines on ARDS, in a patient with moderate-to-severe ARDS (PaO₂/FiO₂ ≤150 mmHg) on conventional ventilation, what is the recommended timing and patient selection for prone positioning?
What is Early (within 36 hours of ARDS onset) for patients with moderate-to-severe ARDS(PaO₂/FiO₂ ≤150 mmHg) on lung-protective ventilation.
According to the 2024 AASLD Practice Guidance for Primary Biliary Cholangitis (PBC), the first-line pharmacologic therapy for patients with PBC is this medication, which should be started as soon as diagnosis is confirmed, even in asymptomatic patients.
What is ursodeoxycholic acid?
These criteria are used to diagnose functional gastrointestinal disorders such as IBS, functional dyspepsia, and functional constipation.
What are the Rome criteria?
I’m used in surgery but I’m not a tool. I help you sleep like a fool. What am I?
Anesthesia
In a patient with LV noncompaction cardiomyopathy and an LV thrombus, according to the 2015 AHA Scientific Statement, which class of medication is recommended for anticoagulation, and for approximately how long?
What is Vitamin K antagonists (warfarin)? Duration: Typically at least 3–6 months, with follow-up imaging to confirm thrombus resolution. (2022 say DOAC may be reasonable alternative though little data
According to the 2023 ELSO and ATS/ESICM/SCCM guidelines, venovenous ECMO should be considered in adults with severe ARDS when conventional management fails. Name the PaO₂/FiO₂ threshold, ventilator strategy requirements, and timing considerations that guide ECMO initiation. (Class IIa)
PaO₂/FiO₂ threshold: ≤80 mmHg for ≥6 hours despite optimal care. Ventilator strategy requirement: On lung-protective ventilation (tidal volume 4–6 mL/kg PBW, plateau pressure ≤30 cmH₂O, appropriate PEEP). Timing considerations: Early initiation (within 6-24hr) is recommended when severe hypoxemia persists, ideally before irreversible organ injury occurs.
According to the 2018 AASLD Hepatitis B Guidance, antiviral therapy is recommended for patients with chronic hepatitis B who have elevated ALT and either HBV DNA above _________ threshold or evidence of significant fibrosis.
The preferred first-line agents due to high potency and low resistance are _____ and ________.
What is:
HBV DNA thresholds: >20,000 IU/mL for HBeAg-positive or >2,000 IU/mL for HBeAg-negative patients. (name at least one correctly)
First-line antivirals: Tenofovir or Entecavir (name at least one correctly)
These criteria are used to diagnose cerebral amyloid angiopathy on imaging.
What are the Boston criteria?
Why did the clown go to the doctor?
Because he was feeling a little funny.
This is the most common congenital heart defect diagnosed in adulthood, and according to the 2020 ACC/AHA Adult Congenital Heart Disease Guidelines.
Name at least two of the three Class I indications for closure.
Secundum atrial septal defect
Indications:
Right heart enlargement
Significant left-to-right shunt (Qp:Qs ≥1.5:1),
Pulmonary vascular resistance below PVR < 5 Wood units
A patient with a tracheostomy suddenly develops massive, pulsatile tracheal bleeding. This rare but catastrophic complication most often occurs within the first 3–4 weeks post-procedure. Name this condition and describe the immediate life-saving maneuver recommended to temporize hemorrhage before definitive surgical repair.
Tracheoinnominate (innominate) fistula. Immediate life-saving maneuver:
Overinflate the tracheostomy cuff to tamponade bleeding. Apply direct pressure via the stoma (Utley maneuver). Prepare for emergent surgical repair. Airway may be maintained — Call cardiothoracic surgery ASAP
According to current expert consensus and ASGE guidelines, AXIOS lumen-apposing metal stents are primarily used for drainage of walled-off pancreatic necrosis or pseudocysts. Compared with plastic stents, these stents reduce the number of interventions, but carry a specific risk unique to their design that must be monitored during follow-up. Name this risk.
Stent migration, bleeding, or buried stent syndrome (particularly delayed bleeding due to erosion into adjacent vessels)
A patient presents with fever, jaundice, and right upper quadrant pain. Labs show leukocytosis and cholestatic liver enzyme elevation, and imaging demonstrates biliary dilation.
According to the guidelines named after a city, name the guidelines and the 3 main types of criteria used for diagnosis of acute cholangitis.
Tokyo Guidelines
Three main types of criteria for diagnosis:
-Systemic inflammation: Fever, elevated WBC or CRP.
-Cholestasis: Jaundice or abnormal liver function tests.
-Imaging findings: Biliary dilation or evidence of etiology (stone, stricture)
What kind of doctor fixes broken websites?
A URL-ologist.