Full Court Blood Pressure
Endocrine Threes
Myeloproliferative Madness
Staying Eligible for Accredidation
Celeb Shots
100
What are the first line anti-HTNs?
Dihydropyridine CCB
ARB/ACE
Thiaziude (preferably chlorthalidone, HCTZ only active for 6-12 hr)
100
How long does a patient need to be on steroids before the HPA axis is significantly suppressed, such that if you wanted to discontinue the steroid you would need to taper to avoid AI?
Necessary if steroid use >3w-4w (independent of dose) = increased risk of HPA suppression.
100
What are the two major mechanisms of EPO-driven polycythemia, and an example of each?
Hypoxia-induced - COPD, OSA, OHS, eisenmenger
Exogenous EPO production - Classically RCC, also can be HCC, fibroids or kidney pathology
100
Does the AMA support Medicare for all?
Nope
in 2019 its delegates voted 53%–47% to maintain its opposition to a single-payer system, rejecting a proposal that would have removed that opposition
They support universal healthcare, but prefer a multi-payer over a single-payer system
100
Which 2 celebs reportedly had a secret marriage this past week?
Zendaya and Tom Holland
200
What is the lab test that should be sent on ALL patients with newly diagnosed HTN that is new to the 2025 guidelines
U Alb:Cr ratio
200
What is the typical dosing for the medication/medications to treat primary adrenal insufficiency in the outpatient setting?
15-25 hydrocort daily - usually 2/3 in AM, 1/3 in PM, alt option is 3-5 pred daily, but hydrocort favored
0.05 -0.1 fludrocortisone daily
Can also consider replacing DHEAs, particularly if patient has mood symptoms and is female (adequate androgen production from testes in males)
200
Darier's sign, a skin reaction where rubbing or scratching a skin lesion causes it to become itchy, red, and swollen (urticated) within 2-5 minutes, is a classic finding in which disorder of myeloproliferation?
Systemic mastocytosis
200
Do we have at least 4 days off in any given 28 day period?
Yes!
200
Which rapper invited the women's hockey team to las vegas?
Flava Flav
300
According to the 2025 guidelines you are encouraged to achieve what BP goal for your patients?
At least < 130/80, but encouraged to target 120/80
Class I if CVD
Class 2B if no CVD
300
Describe what you expect in primary, secondary and tertiary hyperparathyroidism in terms of Ca, PO4 and PTH levels?
300
Which myeloproliferative disorder has the highest risk of progression to AML?
Primary myelofibrosis - 10yr =18%
PMF = Clonal, malignant proliferation of hematopoietic stem cells in the bone marrow, driven by genetic mutations (e.g., JAK2, CALR, MPL). This uncontrolled production of cells triggers abnormal cytokine release, leading to fibrosis (scarring) and secondary blood production in the spleen.
Essential thrombocythemia - 10yr =4.7%
Polycythema vera - 10yr =3.5%
300
Do you have adequate avenues to provide feedback to the residency program?
Yes!
300
Former Jersey Shore star Snooki recently revealed she had which cancer diagnosis?
Cervical cancer - "a dino carcinoma"
400
You receive a call from your night nurse that a patient admitted for a kidney stone that you are cross-covering, has a BP of 190/80. What is this called and what should you do?
Either HTN emergency or asymptomatic severe HTN
Check the prior BPs
Ask or evaluate yourself for HTN emergency/EOD
If no symptoms - gently educate your nursing colleagues on recent changes to the guidelines.
Spontaneous falls in BP without any antihypertensive agents occur commonly, at a rate of 40% to 50%. Tx associated with increased risk of in-hospital mortality, AKI, and prolonged hospital stay.
400
What are the thresholds for an absolute diagnosis, likely diagnosis and a rule out of Adrenal insufficiency for cortisol level? How must it be drawn?
< 3 absolute, <5 likely, ruled out if >15 (some say 18)
6-9 AM
400
What is the mainstay of treatment for low and high risk polycythemia vera?
Low risk = age <60, no prior thrombosis - Aspirin + therapeutic phlebotomy
High risk = all other - Aspirin + therapeutic phlebotomy + cytoreductive agent (Hydroxyurea or pegylated IGNa or ruxolitinib)
Aspirin reduces MACE and thrombosis
Similar management to essential thrombosis
400
What are assignments?
Clinical rotations
400
How did the actor that played McSteamy die?
ALS
500
In patients with newly diagnosed Stage 1 HTN, which patient populations (name 3/4) should be empirically started on anti-HTN and which patient population should be offered 3-6 months of lifestyle changes, then started on anti-HTN (if still elevated)
Primary prevention: Pre-existing CVD (CHF, CVA or CAD)
Secondary Prevention: DM, CKD or 10-yr PREVENT >7.5%
Lifestyle changes first if NONE of the above
500
What clinical features are seen in primary adrenal insufficiency, which are not typically seen in secondary/tertiary (3)?
Primary -> decrease in aldosterone -> orthostasis, hyperk, even worse hypona, salt craving,
Increase in ACTH -> melanin stimulation -> hyperpigmentation
May be comorbid with other autoimmune diseases
Primary more likely to have adrenal crisis than secondary/tertiary
500
Define the CML stages (recently updated in 2024) - chronic, accelerated, and blast. Which stages require treatment?
< 15% blasts
15-30% blasts OR Platelet < 100 (not due to treatment) OR new chromosomal abnormality
>30% blasts or extramedullary infiltration of organs
They ALL should be on TKI regardless of phase
Stages used to be <10, 10-20 and > 20
500
Out of the 9,200 organizations with publically available spending on lobbying, where does the American Medical Association rank in terms of total spent and how much do they spend? Points for whoever is closest to rank and $.
7 in total spent by any lobbying organization - $24,782,000 - 55% democrat, 45% repub
500
The ballerina farm influencer is expecting her nth child this year
9th
