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 Ticagrelor or Prasugrel? (Either is acceptable)
This class of medications is recommended by the 2024 EASL–EASD–EASO guidelines for patients with MASLD and type 2 diabetes to reduce liver-related outcomes.
What are SGLT2 inhibitors? (GLP-1 RAs, currently not recommended for improving "Liver-related outcomes")
The 2024 SCCM guidelines recommend this corticosteroid regimen for septic shock.
What is hydrocortisone 200 mg/day (avoid >400 mg/day equivalents -- recommendation from SCCM against high-dose/short-duration though in favor of the 200mg)? (specify dosage)
This chromosomal abnormality, is named after the city where it was first identified and is characteristic of CML.
What is the Philadelphia chromosome?
What vitamin deficiency causes night blindness?
What is Vitamin A deficiency?
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)?
According to the 2022 ACG Clinical Guideline for Celiac Disease, in adults undergoing serologic testing for celiac disease, patients should be counseled regarding what prior to testing to avoid false-negative results.
ACG (and multiple sources) recommend patients should remain on a gluten-containing diet for testing; recommended durations in guidance vary but are generally 2–6 weeks (many sources use ≥6 weeks as common practice).
According to the 2022 Surviving Sepsis Campaign and ATHOS-3 trial, this synthetic vasopressor is indicated for refractory distributive shock, with a unique mechanism.
What is Angiotensin II (Giapreza) — acts at AT1 receptors → vasoconstriction.
These criteria, named after a UK city, are used to diagnose cerebral amyloid angiopathy on imaging.
What are the Boston criteria?
Why do glucocorticoids cause leukocytosis?
They demarginate neutrophils, raising circulating WBC.
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 (AV nodal block), and observation unless symptomatic?
Atropine or exercise (sympathetic drive): If conduction improves → AV nodal (supra-Hisian). If conduction worsens (more block) or stays the same → infra-Hisian.
Vagal maneuvers (carotid massage, Valsalva): If conduction worsens (more block) → AV nodal (supra-Hisian). If conduction improves (less block) → infra-Hisian.
Mobitz I / suprahissian block: Observation unless symptomatic (Class I: no pacing if asymptomatic).
Mobitz II / infrahissian block (or 2:1 where infra-Hisian suspected): Permanent pacing is Class I recommended, regardless of symptoms.
According to the 2024 AASLD Guidance for PBC, the first-line pharmacologic therapy for patients with PBC is this medication, which should be started as soon as diagnosis is confirmed, even if asymptomatic.
What is Ursodeoxycholic acid (UDCA)?
According to 2023 ARDS guidelines, what is the timing, patient selection, and minimum duration and ventilator target during proning?
What is early proning (within 36 hrs) for patients with "moderate-to-severe" ARDS PaO₂/FiO₂ ≤150 (150 was part of the inclusion criteria for PROSEVA trial), with >12h/day-16hrs sessions, maintaining lung-protective ventilation. Need all 3 for points (timing, P/F ratio, and minimum duration).
These criteria, developed in an Italian city, are used to select HCC patients for transplant.
What are the Milan criteria?
Key to know because (1) patients within criteria have much better survival post-transplant, and (2) liver cancer can be diagnosed without biopsy if classic imaging features are present (arterial enhancement + venous/delayed washout). This avoids biopsy risks like bleeding and tumor seeding.
^this is just teaching
In ACS patients undergoing PCI, IV unfractionated heparin is preferred. But in acute PE, LMWH or DOACs are preferred. Why the difference
Because PCI requires immediate, titratable anticoagulation that can be rapidly monitored and adjusted using activated clotting time (ACT) in the cath lab. Heparin’s short half-life and reversibility make it ideal.
For acute PE, the goal is sustained systemic anticoagulation to prevent clot extension and recurrence. DOACs (or LMWH) are preferred since they have strong trial evidence, predictable dosing, and are effective for long-term therapy.
During PCI, heparin is not stopped. Operators give IV boluses during the procedure to reach and maintain target ACT.
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), typically 3–6 months, with repeat imaging to confirm resolution. (DOACs are being used off label as of 2022 guidelines however most safety data is for warfarin)
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 fibrosis. The preferred first-line agents are:
What is: Tenofovir or Entecavir (HBV DNA thresholds: >20,000 IU/mL if HBeAg+, >2,000 IU/mL if HBeAg–).
According to ELSO/ATS/SCCM guidelines, VV-ECMO should be considered in severe ARDS when conventional management fails. State the PaO₂/FiO₂ threshold, ventilation requirements, and timing.
What is: PaO₂/FiO₂ ≤80 mmHg for ≥6 hrs despite lung-protective ventilation (Vt 4–6 mL/kg, Pplat ≤30). Early initiation (6–24 hrs) before irreversible organ injury.
A patient with fever, jaundice, RUQ pain, labs with cholestasis, and biliary dilation on imaging. According to guidelines named after a city, what are the guidelines and the 3 main diagnostic criteria?
What are the Tokyo Guidelines; systemic inflammation, cholestasis, imaging findings. (Need to say the city + 3 criteria for points)
Why does CRT improve outcomes in LBBB but less so in RBBB?
Because LBBB causes LV dyssynchrony corrected by CRT; RBBB spares LV activation, so less benefit.
This is the most common congenital heart defect diagnosed in adulthood, and according to the 2020 ACC/AHA Adult Congenital Heart Disease Guidelines, Class I indications for closure include:
What is: Secundum ASD; with right heart enlargement, Qp:Qs ≥1.5:1, and PVR < 5 WU. (Need to name the defect + all 3 criteria needed to proceed with closure for points)
According to ASGE guidelines, AXIOS lumen-apposing metal stents are used for drainage of pancreatic collections. Compared with plastic stents, these reduce interventions but carry a unique risk that must be monitored.
What is delayed bleeding (erosion), stent migration, or buried stent syndrome?
A tracheostomy patient develops massive, pulsatile bleeding. This rare but catastrophic complication most often occurs 3–4 weeks post-procedure. Name the condition and the immediate maneuver.
What is tracheoinnominate fistula; overinflate cuff, apply Utley maneuver (finger through incision to apply direct pressure to artery), emergent surgical repair (call CT surgery emergently). (need to name complication and maneuver to stabilize and who to call -- all 3 for points)
After lymphoma treatment, PET/CT shows residual FDG uptake. According to classification named after a city, what scale is used, and what indicates complete response?
What is the Lugano classification using the Deauville 5-point scale. Complete response: score 1–3.
Need all 3
This rare condition often presents with bilateral 'hairy kidneys' and multisystem infiltration. Name it.
What is Erdheim-Chester disease; foamy histiocyte infiltration of perirenal space and renal sinuses causes the hairy kidneys.