NBMEs

Question 1

Important indicator for anticoagulation

Answer 1

Prosthetic heart valves

Question 2

Pt who has a skin rash that resolve but then has it again in two different locations

Answer 2

Probably an autoinfection

Question 3

Patient with CD4 count of >500 and viral load of 2000 or less

Answer 3

Do not start on antiretroviral therapy

Question 4

Tx of patient with unstable AV dissociation

Answer 4

DC cardioversion

Question 5

Young patient with swollen cervical lymph nodes and systemic B sx.

Answer 5

Hodgkin lymphoma

Question 6

Patient who has an obstructive pneumonia due to stage IV cancer but denies any further chemo

Answer 6

Send home with hospice care

Question 7

Best way to prevent hypertensive strokes in the future

Answer 7

Lisinopril therapy

Question 8

Pt with history of heartburn who progressively has trouble swallowing solids

Answer 8

Get an upper endoscopy

Question 9

Patient >40 with a solitary thyroid nodule but no signs of hyperthyroidism

Answer 9

Still get FNA; need to rule out cancer

If negative, THEN you can just monitor

Question 10

Female woman who has dilated intrahepatic ducts, epigastric pain, and increased direct bilirubin

Answer 10

Choledocholithiasis

Causing pancreatitis as well if there is epigastric pain

Question 11

Crescendo-decrescendo murmur along the left sternal border w/ carotid radiation

Answer 11

HCOM

Question 12

Serotonin syndrome presentation

Answer 12

AMS

Autonomic instability

Neuromuscular excitability (tremor, hyperreflexia, myoclonus)

Question 13

NMS syndrome presentation

Answer 13

Fever

AMS

Muscle rigidity

Autonomic instability (arrhythmia, labile BP, tachypnea, diaphoresis)

Causes: Antipsychotics, antiemetics, dopamine agonists, infxn, surgery

Tx: Stop drug, supportive, dantrolene if it doesn’t remit

Question 14

Gift accepting from pharmaceuticals

Answer 14

Small gifts that MUST DIRECTLY BENEFIT PATIENT

Question 15

Otosclerosis pt

Answer 15

Can be a young female

Tx with hearing aids

Question 16

Complication of viral myocarditis

Answer 16

Dilated cardiomyopathy

Echo shows dilated ventricles with diffuse hypokinesia =» decreased EF

Question 17

Lateral mid-pons lesion

Answer 17

Disrupts nuclei of CN V

=» Weakness in muscles of mastication, diminished jaw jerk reflex, and impaired tactile and position sensation on the face

Question 18

Poor prognostic factors of HF

Answer 18

Clinical: Resting tachycardia, S3, Elevated JVP, low bp, mitral regurg, low maximal O2 consumption peak

Lab: **HYPONATREMIA, elevated BNP, renal insufficiency

EKG: Prolonged QRS, LBBB

Echo: SEvere LV dysfnxn, reduced right ventricular fnxn, pulmonary HTN

Question 19

COPD pt who doesn’t respond to normal treatments

Answer 19

Start NONINVASIVE positive-pressure ventilation

Decreases RR and PaCO2

Question 20

VZV is contagious when…

Answer 20

Open vesicles are present

IC

Never had chickenpox

Question 21

VZV vaccination recommendation ion

Answer 21

All patients over 60

Question 22

Pt with mental retardation and has increasing episodes of vomiting after eating and has weight loss

Answer 22

Consider gastric bezoar

Question 23

Pt who has history of travel, abdominal bloating, increasing flatulence, and diarrhea that is non-blood and foul smelling

Answer 23

ETEC?

Question 24

Treatment of acute RA exacerbation

Answer 24

NSAIDs

DONT FALL FOR JOINT INJXN

Question 25

Patient who has a cough but it is mostly when she is in bed at night but also has signs of wheezes

Answer 25

Sounds like asthma

Question 26

Patient who is currently on antihypertensive therapy and wants to start a new experimental drug? What kind of study is this?

Answer 26

Randomized controlled trial of a drug X versus standard therapy?

Question 27

UC association

Answer 27

PRIMARY SCLEROSING CHOLANGITIS

Question 28

Pt who initially has an insect bite on their cheek that progresses to eye swelling and abnormal ocular movements

Answer 28

Cavernous sinus thrombosis Ophthalmic venous system is valveless =>> uncontrolled infxn Other S/s: Headache, papilledema, binocular palsies, hyperesthesia Dx: MR venography Tx: Broad-spectrum abx; prevent cerebral herniation

Question 29

If a patient has deviation of the eyes towards one side after a stroke

Answer 29

Probably a putamen hemorrhage

Question 30

Patient with bacterial endocarditis and recently had a dental thing done

Answer 30

Consider Eikenella corrodens

Question 31

First line treatment for pulmonary HTN DUE TO HF

Answer 31

ACEIs and Diuretics Endothelin-antagonists used for idiopathic pulmonary HTN

Question 32

Tx for complete heart block

Answer 32

Cardiac pacing; regardless of stability

Question 33

Diabetic opthalmoplegia

Answer 33

Causes CNIII palsy with preserved pupillary response

Question 34

Patient who presents with a history of difficulty initiating swallow with food getting stck in the throat while swallowing

Answer 34

Likely oropharyngeal dysphagia GET A VIDEOFLUOROSCOPIC MODIFIED BARIUM SWALLOW

Question 35

Pt with mental retardation and has increasing episodes of vomiting after eating and has weight loss

Answer 35

Consider gastric bezoar

Question 36

Pt who has history of travel, abdominal bloating, increasing flatulence, and diarrhea that is non-blood and foul smelling

Answer 36

ETEC?

Question 37

Treatment of acute RA exacerbation

Answer 37

NSAIDs DONT FALL FOR JOINT INJXN

Question 38

Patient who has a cough but it is mostly when she is in bed at night but also has signs of wheezes

Answer 38

Sounds like asthma

Question 39

Patient who is currently on antihypertensive therapy and wants to start a new experimental drug? What kind of study is this?

Answer 39

Randomized controlled trial of a drug X versus standard therapy?

Question 40

UC association

Answer 40

PRIMARY SCLEROSING CHOLANGITIS

Question 41

Pt who initially has an insect bite on their cheek that progresses to eye swelling and abnormal ocular movements

Answer 41

Cavernous sinus thrombosis Ophthalmic venous system is valveless =>> uncontrolled infxn Other S/s: Headache, papilledema, binocular palsies, hyperesthesia Dx: MR venography Tx: Broad-spectrum abx; prevent cerebral herniation

Question 42

If a patient has deviation of the eyes towards one side after a stroke

Answer 42

Probably a putamen hemorrhage

Question 43

Patient with bacterial endocarditis and recently had a dental thing done

Answer 43

Consider Eikenella corrodens

Question 44

First line treatment for pulmonary HTN DUE TO HF

Answer 44

ACEIs and Diuretics Endothelin-antagonists used for idiopathic pulmonary HTN

Question 45

Tx for complete heart block

Answer 45

Cardiac pacing; regardless of stability

Question 46

Diabetic opthalmoplegia

Answer 46

Causes CNIII palsy with preserved pupillary response

Question 47

Patient who presents with a history of difficulty initiating swallow with food getting stck in the throat while swallowing

Answer 47

Likely oropharyngeal dysphagia GET A VIDEOFLUOROSCOPIC MODIFIED BARIUM SWALLOW

Question 48

Pt with upper abdominal pain, long history of drinking, nausea, vomiting, fever, tachcardia, hypotension, hypocalcemia, occult blood positive

Answer 48

Pancreatitis Patient has had some hemorrhage as well in this case

Question 49

Biggest indicator of a possible heart attack during surgery

Answer 49

History of MI in last 6 months

Question 50

PKD inheritance risk?

Answer 50

Go with 50% yah dingus

Question 51

Pt who has a history of a swollen, erythematous joint that is getting worse but has no fever

Answer 51

Still need to aspirate to r/o septic arthritis

Question 52

Risk factor screening in HIV pts.

Answer 52

Toxoplasma IgG abs Hepatitis B surface abs PPD

Question 53

Felty Syndrome blood levels

Answer 53

PANCYTOPENIA; YOUVE BEEN LIED TO

Question 54

PT with hypotension who is having trouble oxygenating their blood

Answer 54

Consider problem with increased vascular permeability

Question 55

Pt with well controlled diabetes but what drug do they need to be on to decrease complications?

Answer 55

ACEI; DONT CARE IF THEIR AIC IS GREAT

Question 56

Rash that is on pts. neck and face and she spent times in a rose garden

Answer 56

Listen dawg, people aren't that stupid Weeds caused this rash She didn't poke herself in the face with a rose thorn

Question 57

Do pts. with Klinefelter's need to be retarded?

Answer 57

Nope; this sucks because that's usually a give away

Question 58

Hcrt rule

Answer 58

Hgbx3 = Hcrt Consider this for RBC transfusion thresholds

Question 59

VZV late lesions

Answer 59

Have little tiny scabs on them ya dingus Look like black dots

Question 60

Culture of a lesion that looks like contact dermatitis but grows CNS

Answer 60

Lol it's still contact dermatitis yah dingus

Question 61

Vitreous hemorrhage

Answer 61

Sudden loss of vision with onset of floaters most commonly caused by diabetic retinopathy *Fundus is hard to visualize; will see floating debris and dark red glow

Question 62

Go to test for suspected histoplasmosis

Answer 62

Urine antigen test Forgo the blood cx

Question 63

Mammogram screening recommendations

Answer 63

Every 2 years from the age of 50-75

Question 64

Hyperlipidemia screening recommendations

Answer 64

Men 35+ every 5 years

Question 65

Pt who develops afib secondary to hyperthyroidism

Answer 65

Treat with a BB