5/26/16

1

InternalMedicine• Teamcaptains picksquestion fortheir

teamto answer• Everyoneon teamvotes– captain can

choose consensus answerorgorogue• Ifateamanswerscorrectly, theyretain

control oftheboardforupto3questions• Ifateamanswersincorrectly, theother

teamtakescontrol ofthe board

JeopardyRules

$1 00

$200

$300

$500

$400

A Disease Called Fame

$1 00

$200

$300

$500

$400

Were You Sleeping?

$1 00

$200

$300

$500

$400

A Closer Look

$1 00

$200

$300

$500

$400

Rainbow of Medicine

$1 00

$200

$300

$500

$400

Medical Zoo

Final Jeopardy

The Angelina Jolie Effect refers to the increased number of women who underwent bilateral mastectomy due to the BRCA mutation after the actress reveal that her decision to do this. What other cancers are more common in patients with BRCA 1 or 2 mutation?A. PancreaticB. OvarianC. ProstateD. Papillary thyroid

A. B. C. D.

18%

45%

30%

6%

5/26/16

2

Main Board

The Angelina Jolie Effect refers to the increased number of women who underwent bilateral mastectomy due to the BRCA mutation after the actress reveal that her decision to do this. What other cancers are more common in patients with BRCA 1 or 2 mutation?A. PancreaticB. OvarianC. ProstateD. Papillary thyroid

Arnold Schwarzenegger’s most famous Hollywood role was that of the Terminator cyborg. In real life, he had bicuspid aortic valve replaced with a prosthesis. He should receive endocarditis prophylaxis for:

A. Colonoscopy

B. Tooth extraction

C. Both A & B

D. Neither

A. B. C. D.

4%

46%

27%23%

Main Board

A. Colonoscopy

B. Tooth extraction

C. Both A & B

D. Neither

Arnold Schwarzenegger’s most famous Hollywood role was that of the Terminator cyborg. In real life, he had bicuspid aortic valve replaced with a prosthesis. He should receive endocarditis prophylaxis for:

Gluten sensitivity is a popular diagnosis among the Hollywood set. True celiac sprue is associated with all of the following auto-antibodies EXCEPT:

A. Anti-myeloperoxidase

B. Anti-gliadin

C. Anti-tissue transglutamidase

D. Anti-reticulin

A. B. C. D.

52%

44%

4%0%

5/26/16

3

Main Board

Gluten sensitivity is a popular diagnosis among the Hollywood set. True celiac sprue is associated with all of the following auto-antibodies EXCEPT:

A. Anti-myeloperoxidase

B. Anti-gliadin

C. Anti-tissue transglutamidase

D. Anti-reticulin

Some celebrities have voiced opposition to vaccination due to incorrect beliefs about its safety. Which of the following celebrities have publicly voiced support for childhood vaccination?

A. Jim Carrey

B. Donald Trump

C. Steven Colbert

D. Robert De Niro

A. B. C. D.

8%12%

72%

8%

Main Board

Some celebrities have voiced opposition to vaccination due to incorrect beliefs about its safety. Which of the following celebrities have publicly voiced support for childhood vaccination?

C. Steven Colbert

A. Hypothyroidism

B. Hypoparathyroidism

C. Pseudohypoparathyroidism

D. Pseudo-pseudohypoparathyroidism

Game of Thrones actor Peter Dinklage’s short stature is due to a form of achondroplasia. Which of the following conditions can also cause growth delay?

5/26/16

4

Game of Thrones actor Peter Dinklage’s short stature is due to a form of achondroplasia. Which of the following

conditions can also cause growth delay?A. Hypothyroidism

B. Hypoparathyroidism

C. Pseudohypoparathyroidism

D. Pseudo-pseudohypoparathyroidism

A. B. C. D.

43%

29%

14%14%

A. Hypothyroidism

B. Hypoparathyroidism

C. Pseudohypoparathyroidism

D. Pseudo-pseudohypoparathyroidism

Main Board

Game of Thrones actor Peter Dinklage’s short stature is due to a form of achondroplasia. Which of the following conditions can also cause growth delay?

A young man presents with painless hematuria. The urine microscopy finding below supports a diagnosis of:A. Hemolysis

B. Renal calculus

C. Focal segmental glomerulosclerosis

D. IgA nephropathy

A. B. C. D.

0%

35%

61%

4%

Main Board

A. Hemolysis

B. Renal calculus

C. Focal segmental glomerulosclerosis

D. IgA nephropathy

A young man presents with painless hematuria. The urine microscopy finding below supports a diagnosis of:

5/26/16

5

A patient is admitted with fever, anemia, and thrombocytopenia. The peripheral blood smear below supports a diagnosis of:A. Immune thrombocytopenic purpuraB. Autoimmune thromboyctopenia and

hemolytic anemiaC. Thrombotic thrombocytopenic purpuraD. Sickle cell anemia

A. B. C. D.

0%

21%

75%

4% Main Board

A patient is admitted with fever, anemia, and thrombocytopenia. The peripheral blood smear below supports a diagnosis of:

A. Immune thrombocytopenic purpuraB. Autoimmune thromboyctopenia and

hemolytic anemiaC. Thrombotic thrombocytopenic purpuraD. Sickle cell anemia

A woman complains of pruritic vaginal discharge. You perform a wet mount (shown below) and prescribe:A. Metronidazole PO

B. Doxycycline PO

C. Fluconazole PO

D. Hydrocortisone topical

A. B. C. D.

85%

0%6%9%

Main Board

A woman complains of pruritic vaginal discharge. You perform a wet mount (shown below) and prescribe:A. Metronidazole PO

B. Doxycycline PO

C. Fluconazole PO

D. Hydrocortisone topical

Trichomonas(motile)

5/26/16

6

While working in South Sudan, you encounter a woman with headache and fever. You perform a lumbar puncture. The CSF gram stain below indicates:A. Meningococcal meningitis

B. Cryptococcal meningitis

C. Dengue Fever

D. Tuberculosis

A. B. C. D.

63%

6%

19%13%

Main Board

While working in South Sudan, you encounter a woman with headache and fever. You perform a lumbar puncture. The CSF gram stain below indicates:A. Meningococcal meningitis

B. Cryptococcal meningitis

C. Dengue Fever

D. Tuberculosis

A. Acute gout

B. Acute pseudogout (CPPD)

C. Reactive arthritis

D. Septic arthritis

A. B. C. D.

22%

3%3%

72%

An elderly man presents with a painful, swollen left knee. Arthrocentesis yields a slightly cloudy fluid with 20,000 wbc (mostly PMNs). Polarized light microscopy of the fluid (shown below) indicates:

Arrow shows slow axis of compensator

Main Board

A. Acute gout

B. Acute pseudogout (CPPD)

C. Reactive arthritis

D. Septic arthritis

An elderly man presents with a painful, swollen left knee. Arthrocentesis yields a slightly cloudy fluid with 20,000 wbc (mostly PMNs). Polarized light microscopy of the fluid (shown below) indicates:

Arrow shows slow axis of compensator

5/26/16

7

What is the mechanism of unilateral scleral icterus?

A. CMV Hepatitis B. Mirizzi’s SyndromeC. Prosthetic EyeD. Cholangiocarcinoma

A. B. C. D.

0%4%

71%

25%

What is the mechanism of unilateral scleral icterus?

A. CMV Hepatitis B. Mirizzi’s SyndromeC. Prosthetic EyeD. Cholangiocarcinoma

Main Board

A patient is noted by his nurse to be producing blue urine… how did this happen?

A. Pseudomonas UTIB. Amitriptyline IngestionC. Copper PoisoningD. Porphyria

A. B. C. D.

21%

36%

43%

0%

A patient is noted by his nurse to be producing blue urine… how did this happen?

A. Pseudomonoas UTIB. Amitriptyline IngestionC. Copper PoisoningD. Porphyria

Main Board

5/26/16

8

Which of the following does

NOT cause blue sclera?

A. Wilson’s diseaseB. Osteogenesis imperfectaC. Ehlers-Danlos SyndromeD. Marfan’s Disease

A. B. C. D.

47%44%

6%3%

Which of the following does

NOT cause blue sclera?

A. Wilson’s diseaseB. Osteogenesis imperfectaC. Ehlers-Danlos SyndromeD. Marfan’s Disease

Main Board

Which of the following does NOT turn the urine black?

A. Metastatic melanomaB. Methylene blue C. AlkaptonuriaD. Hemolysis due to malaria

A. B. C. D.

70%

5%10%

15%

Which of the following does NOT turn the urine black?

A. Metastatic melanomaB. Methylene blue C. AlkaptonuriaD. Hemolysis due to malaria

Main Board

5/26/16

9

What disease process creates silver-colored stool?

A. Hepatocellular CarcinomaB. Esophageal CancerC. Gastric CancerD. Cancer of Ampulla of Vater

A. B. C. D.

0%

88%

6%6%

What disease process creates silver-colored stool?

A. Hepatocellular CarcinomaB. Esophageal CancerC. Gastric CancerD. Cancer of Ampulla of Vater

Main Board

While sitting on a beach in Australia, you encounter a woman who develops sudden flaccid paralysis after swimming. She doesn’t complain of pain. What animal attacked her?

A B C D

B. Blue Ringed Octopus

Main Board

While sitting on a beach in Australia, you encounter a woman who develops sudden flaccid paralysis after swimming. She doesn’t complain of pain. What animal attacked her?

5/26/16

10

Described in Japanese patients with ST elevations and clean coronaries, this syndrome involves left apical ballooning that mimics these octopus-catching contraptions.

A. Kawasaki’s diseaseB. Takatsubo’s diseaseC. Takayasu’s diseaseD. Katayama disease

A. B. C. D.

14%

4%

25%

57%

Described in Japanese patients with ST elevations and clean coronaries, this syndrome involves left apical ballooning that mimics these octopus-catching contraptions.

A. Kawasaki’s diseaseB. Takatsubo’s diseaseC. Takayasu’s diseaseD. Katayama disease

Main Board

Which animal in this picture is most likely to transmit Bartonella henselae if it bites you?

A. The dogB. The catC. The ratD. The human

A. B. C. D.

0% 3%

34%

63%

Main Board

Bartonella henselae infection is associated with the bite from what animal?

B. The cat

5/26/16

11

What disease is caused by this bug?

A. Lyme DiseaseB. Chaga’s DiseaseC. ErlichiosisD. Uncomfortable rashE. Ascending paralysis

A. B. C. D. E.

40%

32%

0%

24%

4% Main Board

What disease is caused by this bug?

A. Lyme DiseaseB. Chaga’s DiseaseC. ErlichiosisD. Uncomfortable rashE. Ascending paralysis

The venom of the Gila Monster is the basis of a drug used to treat:

A. DiabetesB. Heparin-induced thrombocytopeniaC. Breast cancerD. Acute coronary syndrome

A. B. C. D.

32%

18%14%

36%

Main Board

The venom of the Gila Monster is the basis of a drug used to treat:

A. Diabetes (Exenatide)B. Heparin-induced thrombocytopeniaC. Breast cancerD. Acute coronary syndrome

5/26/16

12

Which of the following is a typical requirement for physician aid in dying (PAD) laws such as the California’s End of Life Options Act?

A. Psychiatry evaluation requiredB. Can be requested in advanced directiveC. Cannot be requested by designated surrogateD. Patient must be enrolled in hospice

A. B. C. D.

18% 18%

61%

3%Main Board

Which of the following is a typical requirement for physician aid in dying (PAD) laws such as the California’s End of Life Options Act?

A. Psychiatry evaluation requiredB. Can be requested in advanced directiveC. Cannot be requested by designated surrogateD. Patient must be enrolled in hospice

In a 2015 meta-analysis, listening to music perioperatively was associated with all of the following outcomes except:

A. Reduced length of stayB. Reduced postoperative painC. Less anxietyD. Improved satisfaction

A. B. C. D.

70%

21%

9%

0% Main Board

In a 2015 meta-analysis, listening to music perioperatively was associated with all of the following outcomes except:

A. Reduced length of stayB. Reduced postoperative painC. Less anxietyD. Improved satisfaction

5/26/16

13

Screening for HCV infection is recommended by the CDC and USPSTF for all:

A. Baby boomersB. MSMC. Blood transfusion recipientsD. Patients with prior HBV infection

A. B. C. D.

44%

11%

26%

19%

Main Board

Screening for HCV infection is recommended by the CDC and USPSTF for all:

A. Baby boomersB. MSMC. Blood transfusion recipientsD. Patients with prior HBV infection

Compared to warfarin, a left atrial appendage occlusion device (Watchman) has all the following effects EXCEPT:

A. B. C. D.

22% 22%

44%

11%

A. Fewer hemorrhagic strokesB. Less non-procedural bleedingC. More ischemic strokesD. More CV/unexplained deaths

Main Board

Compared to warfarin, a left atrial appendage occlusion device (Watchman) has all the following effects EXCEPT:A. Fewer hemorrhagic strokesB. Less non-procedural bleedingC. More ischemic strokesD. More CV/unexplained deaths

5/26/16

14

How much of what you learned from a medical lecture today will be remembered tomorrow?

A. 80%B. 60%C. 40%D. 20%

How much of what you learned from a medical lecture today will be remembered tomorrow?

A. 80%B. 60%C. 40%D. 20%

Main Board

W61.62XD is the ICD-10 code for:

A. Spacecraft collision injuring occupant, sequelae

B. Struck by duck, subsequent encounter

C. Problems in relations with in-laws

D. Other contact with cow, subsequent encounter

A. B. C. D.

25% 25%25%25%

7

W61.62XD is the ICD-10 code for:

A. Spacecraft collision injuring occupant, sequelaeB. Struck by duck, subsequent encounterC. Problems in relations with in-lawsD. Other contact with cow, subsequent encounter