6/21/2019 Advances in Internal Medicine What a Let it Bugs & Pain & Jeopardy Rules Potpourri Drag… Bleed Drugs Suffering • Team captain selects question for their $100 $100 $100 $100 $100 team to answer by ARS voting • Everyone on team votes – captain can $200 $200 $200 $200 $200 accept consensus answer or veto • A correct answer lets a team select one $300 $300 $300 $300 $300 additional question (maximum 2) • After an incorrect answer or 2 correct $400 $400 $400 $400 $400 answers, control of the board switches to the other team $500 $500 $500 $500 $500 Final Jeopardy 1
6/21/2019 A 70-year-old man with 30 pack-years of smoking A 70-year-old man with 30 pack-years of smoking who quit 10 years ago asks whether he’s too old who quit 10 years ago asks whether he’s too old to benefit from lung cancer screening. to benefit from lung cancer screening. Which statement is true? Which statement is true? A. He’s too old per USPSTF A. He’s too old per USPSTF guideline guideline 83% B. He hasn’t had enough B. He hasn’t had enough exposure (insufficient pack- exposure (insufficient pack- years) years) C. He quit too long ago C. He quit too long ago D. The false positive rate is D. The false positive rate is 13% over 90% over 90% 4% 0% Main Board A. B. C. D. You are taking care of an elderly rock star with You are taking care of an elderly rock star with critical aortic stenosis. Which statement about critical aortic stenosis. Which statement about transcatheter aortic valve replacement (TAVR) is transcatheter aortic valve replacement (TAVR) is correct? correct? A. In low risk patients, TAVR A. In low risk patients, TAVR outcomes are better than 84% outcomes are better than surgical valve replacement surgical valve replacement B. In intermediate & high risk B. In intermediate & high risk patients, TAVR outcomes patients, TAVR outcomes are equivalent to surgical are equivalent to surgical valve replacement valve replacement C. Long term valve function 8% C. Long term valve function 4% 4% remains uncertain remains uncertain A. B. C. D. D. All of the above are true D. All of the above are true Main Board 2
6/21/2019 The ASPREE study randomized an elderly cohort The ASPREE study randomized an elderly cohort without known CV disease to aspirin or placebo. without known CV disease to aspirin or placebo. Which of the following outcomes was better (less Which of the following outcomes was better (less frequent) in the aspirin arm? frequent) in the aspirin arm? 72% A. Major bleeding A. Major bleeding B. CV disease B. CV disease C. Cancer-related mortality C. Cancer-related mortality D. None of the above D. None of the above 11% 11% 6% Main Board A. B. C. D. Which of the following is a limitation of the FRAX Which of the following is a limitation of the FRAX model with regards to predicting fracture risk in model with regards to predicting fracture risk in elderly patients? elderly patients? A. It only applies to women A. It only applies to women 44% B. It only provides relative risk (not B. It only provides relative risk (not absolute risk) absolute risk) 32% C. Results not validated for patients C. Results not validated for patients on osteoporosis treatment on osteoporosis treatment 16% D. It doesn’t account for smoking or D. It doesn’t account for smoking or alcohol use alcohol use 8% Main Board A. B. C. D. 3
6/21/2019 Which statement about Sacubitril/Valsartan Which statement about Sacubitril/Valsartan (Entresto) is true? (Entresto) is true? A. It is most effective when added to A. It is most effective when added to ACE-inhibitor therapy ACE-inhibitor therapy 78% B. Patients should be stabilized on an B. Patients should be stabilized on an ACE-inhibitor or angiotensin ACE-inhibitor or angiotensin receptor blocker before starting receptor blocker before starting Sacubitril/Valsartan Sacubitril/Valsartan C. It prevented HF-related C. It prevented HF-related hospitalization better than an ACE- hospitalization better than an ACE- inhibitor inhibitor 11% 11% D. It is effective for heart failure with D. It is effective for heart failure with both reduced and preserved both reduced and preserved 0% ejection fraction ejection fraction A. B. C. D. Main Board For small (< 3 mm) incidental, unruptured intra-cranial For small (< 3 mm) incidental, unruptured intra-cranial aneurysms, a comparative effectiveness analysis aneurysms, a comparative effectiveness analysis concluded that the best management is: concluded that the best management is: 83% A. Do nothing A. Do nothing B. Yearly MRI B. Yearly MRI C. Biannual MRI C. Biannual MRI D. Endovascular coiling D. Endovascular coiling 10% 7% 0% Main Board A. B. C. D. 4
6/21/2019 Which statement about use of direct-acting oral Which statement about use of direct-acting oral anticoagulants (DOAC) in atrial fibrillation is anticoagulants (DOAC) in atrial fibrillation is INCORRECT? INCORRECT? A. They should not be used in A. They should not be used in 63% patients with severe mitral patients with severe mitral stenosis stenosis B. They should not be used with B. They should not be used with mechanical heart valves mechanical heart valves C. Reversal agents should be C. Reversal agents should be given for uncontrolled bleeding given for uncontrolled bleeding 19% D. They remain effective after 13% D. They remain effective after bariatric surgery 6% bariatric surgery Main Board A. B. C. D. A patient on aspirin & clopidogrel for a drug-eluting A patient on aspirin & clopidogrel for a drug-eluting coronary stent who develops atrial fibrillation is coronary stent who develops atrial fibrillation is most likely to benefit from taking: most likely to benefit from taking: A. Aspirin + Clopidogrel + A. Aspirin + Clopidogrel + Anticoagulant Anticoagulant B. Aspirin + Anticoagulant B. Aspirin + Anticoagulant 54% C. Clopidogrel + Anticoagulant C. Clopidogrel + Anticoagulant D. Aspirin + Clopidogrel D. Aspirin + Clopidogrel 36% 11% 0% Main Board A. B. C. D. 5
6/21/2019 Which statement about continuing aspirin through Which statement about continuing aspirin through the perioperative period in a patient with coronary the perioperative period in a patient with coronary artery disease is true? artery disease is true? A. Bleeding risk does not increase A. Bleeding risk does not increase 100% B. Overall mortality risk decreases B. Overall mortality risk decreases C. Patients with coronary stents are C. Patients with coronary stents are more likely to benefit more likely to benefit D. The AHA & ACC give it a grade 1 D. The AHA & ACC give it a grade 1 recommendation recommendation 0% 0% 0% Main Board A. B. C. D. Your patient complains of acute right leg pain and Your patient complains of acute right leg pain and swelling. Ultrasound shows thrombus in the swelling. Ultrasound shows thrombus in the superficial femoral vein. According to ACCP superficial femoral vein. According to ACCP guidelines, how should this patient be managed? guidelines, how should this patient be managed? A. Anticoagulation is strongly A. Anticoagulation is clearly 54% recommended recommended B. Anticoagulation is optional, B. Anticoagulation is optional, but favored if the affected but favored if the affected segment is > 5 cm long segment is > 5 cm long C. Anticoagulation is optional, C. Anticoagulation is optional, but favored if the patient but favored if the patient 21% has cancer or prior VTE has cancer 14% D. If anticoagulation is desired, D. If anticoagulation is desired, 11% fondaparinux is somewhat fondaparinux is somewhat preferred over LMWH preferred over LMWH Main Board A. B. C. D. 6
6/21/2019 After treatment for Clostridium difficile associated After treatment for Clostridium difficile associated diarrhea with metronidazole, a patient has a mild diarrhea with metronidazole, a patient has a mild recurrence. What should be prescribed now? recurrence. What should be prescribed now? 72% A. Metronidazole orally A. Metronidazole orally B. Vancomycin orally B. Vancomycin orally C. Vancomycin slow taper C. Vancomycin slow taper D. Fidaxomicin D. Fidaxomicin 24% 3% 0% Main Board A. B. C. D. Which of these statements about treatment of Which of these statements about treatment of chronic HCV infection with an anti-viral agent is true? chronic HCV infection with an anti-viral agent is true? A. The success rate is around 75% A. The success rate is around 75% B. After successful treatment, B. After successful treatment, regular HCV viral load testing is 59% regular HCV viral load testing is not needed not needed C. Patients will be immune to HCV C. Patients will be immune to HCV after treatment after treatment 32% D. Patients with decompensated D. Patients with decompensated cirrhosis should still be treated cirrhosis should still be treated 5% 5% A. B. C. D. Main Board 7
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