Things Found in a Junk Drawer
Bad Wi-Fi Spots
Reasons My Coffee Went Cold
The Vending Machine Was Out Of
Stuff You Forgot to Return
100
Give two causes of epsilon waves on the EKG.
1. Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC/ARVD)
2. Hypothermia
100
A patient from sub-Saharan Africa presents with cyclic fevers and ring-form trophozoites in >5% of RBCs on thin blood smear. Name the organism and treatment.
Plasmodium falciparum (severe malaria)
use ACT/Artemether-lumefantrine (Coartem) or atovaquone-proguanil
100
Per the ARDSNet ARMA trial, what tidal volume (in mL/kg ideal body weight) is the target in lung-protective ventilation for ARDS?
6 mL/kg ideal body weight (plateau pressure ≤ 30 cmH2O)
100
Name the four components of the Charcot triad and what adding hypotension and altered mental status creates.
RUQ pain, fever, jaundice = Charcot triad. Adding hypotension + AMS = Reynolds pentad — acute suppurative cholangitis
100
Name at least two FDA-approved medications targeting the complement cascade
Eculizumab — C5 inhibitor → PNH, aHUS.
Ravulizumab — C5 inhibitor, longer half-life → PNH, aHUS.
Avacopan — C5a receptor antagonist → ANCA vasculitis.
Pegcetacoplan — C3 inhibitor → PNH
200
A patient with HOCM has an LVOT gradient of 75 mmHg at rest and has failed disopyramide and maximal beta-blockade. Name the FDA-approved medication indicated for symptomatic obstructive HCM.
Answer should include both name and mechanism of action.
1. Mavacamten (Camzyos)
2. Cardiac Myosin Inhibitor
200
Per IDSA HAP/VAP guidelines, the 'HCAP' category was abandoned. On what principle should empiric antipseudomonal and anti-MRSA coverage now be based?
Individual patient risk factor stratification (not hospitalization setting alone)
200
Name the four venous structures assessed in the VEXUS grading system, the Doppler waveform pattern that defines Grade 3 (severe) venous congestion
IVC ≥2 cm required to qualify. Four structures: hepatic vein — monophasic flow; portal vein — pulsatile >30% variation; intrarenal vein — biphasic or discontinuous pattern; IVC — plethoric non-collapsible.
Grade 3 = severe abnormality in ≥2 of the three organ veins
200
In upper GI bleed, a Glasgow-Blatchford score of ________ identifies patients appropriate for Safe outpatient discharge (<1% risk of needing intervention).
0 - Zero
200
Name the first-in-class non-opioid analgesic FDA-approved in 2025
suzetrigine (Journavx)
Selective Nav1.8 sodium channel blocker — blocks pain signal transmission in peripheral nociceptors without CNS opioid effects
300
The DANGER-SHOCK trial (2024) compared two mechanical circulatory support devices in AMI-cardiogenic shock. Name both devices compared and state which showed significantly lower 180-day mortality.
Impella CP vs. IABP — Impella CP showed significantly lower 180-day mortality
300
Describe the CD4 threshold at which PCP prophylaxis should be initiated in HIV patients, the first-line agent, and the alternative in sulfa allergy.
CD4 <200 cells/μL; TMP-SMX; dapsone or atovaquone in sulfa allergy
300
Name the four criteria of the CURB-65 score, the threshold that mandates inpatient admission. Answer atleast 3/4.
CURB-65: Confusion, Urea >7 mmol/L, RR ≥30, BP <90/60, age ≥65. Score ≥2 = inpatient; ≥3 = ICU consideration.
300
After large-volume paracentesis (>5L) in a cirrhotic patient, what post-procedure intervention is recommended to prevent paracentesis-induced circulatory dysfunction (PICD), and at what dose?
IV albumin 6–8 g per liter of ascites removed
300
This FDA-approved (2023) drug is used for the acute termination of paroxysmal supraventricular tachycardia (PSVT) without IV access. Name the drug, MOA, and ROA. Answer all three.
Etripamil (Cardamyst) — intranasal verapamil analog
L-type calcium channel blocker → slows AV nodal conduction; route: intranasal (self-administered)
400
In low-flow low-gradient AS with EF <50%, what test distinguishes true severe AS from pseudo-severe AS?
Dobutamine stress echocardiography
400
Name the two toxins responsible for toxic shock syndrome in S. aureus and S. pyogenes, respectively. Answer both.
S. aureus: TSST-1. S. pyogenes: SpeA/SpeC. Both are superantigens — bypass normal antigen presentation, directly crosslink MHC II and TCR Vβ → massive cytokine storm
400
In ICU-acquired pulmonary aspergillosis (IAPA) in a COPD patient on steroids, what BAL biomarker (with index ≥1.0) is most sensitive for diagnosis, and what is the first-line treatment?
BAL galactomannan (index ≥1.0); first-line treatment is voriconazole
400
State the three most common causes of upper GI bleed in order of frequency.
Peptic ulcer disease, esophageal varices, Mallory-Weiss tear
400
Name the drug class and mechanism of action of ubrogepant (Ubrelvy), FDA-approved for acute migraine treatment.
Calcitonin gene-related peptide (CGRP) receptor antagonist → blocks CGRP-mediated vasodilation and trigeminal pain signaling
500
This antiarrhythmic, used for paroxysmal AF, can paradoxically organize AF into a slower atrial flutter with dangerous 1:1 AV conduction.
Name the drug, class, and MOA (Answer any 2)
1. Flecanide, Class IC, Sodium Channel blocker
Flecainide (Class IC) blocks sodium channels, slowing atrial conduction in AF — paradoxically organizing it into 1:1 flutter. Always co-prescribe a beta-blocker or CCB to block AV conduction.
500
In HIV-associated cryptococcal meningitis with elevated ICP, this trial evaluated whether this drug would improve outcomes. What drug did they use, what did the trial find, and what is the clinical implication?
Answer any two.
1. Dexamethasone
2. Increased Mortality in the intervention group
3. It is contraindicated in HIV-associated cryptococcal meningitis
Crytodex trial
500
Per the PROSEVA trial, what is the P/F ratio cutoff for initiating prone positioning in ARDS, the minimum required session duration, and the 28-day mortality benefit? Answer any two.
P/F < 150; ≥16 hours per session; mortality 16% (prone) vs. 32.8% (supine)
500
State at least 3 diagnostic scoring components of Wilson's disease using the Leipzig scoring system.
Leipzig score: Kayser-Fleischer rings, neuropsychiatric symptoms, Coombs-negative hemolytic anemia, low ceruloplasmin, elevated 24-hr urine copper, liver biopsy copper. Score ≥4 = diagnosis.
500
Per the 2023 KDIGO anemia guidelines, a new class of oral agents has emerged as an alternative to erythropoiesis-stimulating agents (ESAs) like epoetin alfa in non-dialysis and dialysis CKD. Name the drug class and its mechanism of action. Answer any one.
Roxadustat/Daprodustat
HIF prolyl hydroxylase inhibitors (HIF-PHIs); they stabilize HIF-1α → increase endogenous EPO production and improve iron utilization