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Flashcards in NBMEs Deck (65):
1

Important indicator for anticoagulation

Prosthetic heart valves

2

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

Probably an autoinfection

3

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

Do not start on antiretroviral therapy

4

Tx of patient with unstable AV dissociation

DC cardioversion

5

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

Hodgkin lymphoma

6

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

Send home with hospice care

7

Best way to prevent hypertensive strokes in the future

Lisinopril therapy

8

Pt with history of heartburn who progressively has trouble swallowing solids

Get an upper endoscopy

9

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

Still get FNA; need to rule out cancer

If negative, THEN you can just monitor

10

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

Choledocholithiasis

Causing pancreatitis as well if there is epigastric pain

11

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

HCOM

12

Serotonin syndrome presentation

AMS

Autonomic instability

Neuromuscular excitability (tremor, hyperreflexia, myoclonus)

13

NMS syndrome presentation

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

14

Gift accepting from pharmaceuticals

Small gifts that MUST DIRECTLY BENEFIT PATIENT

15

Otosclerosis pt

Can be a young female

Tx with hearing aids

16

Complication of viral myocarditis

Dilated cardiomyopathy

Echo shows dilated ventricles with diffuse hypokinesia =>> decreased EF

17

Lateral mid-pons lesion

Disrupts nuclei of CN V

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

18

Poor prognostic factors of HF

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

19

COPD pt who doesn't respond to normal treatments

Start NONINVASIVE positive-pressure ventilation

Decreases RR and PaCO2

20

VZV is contagious when...

Open vesicles are present

IC

Never had chickenpox

21

VZV vaccination recommendation ion

All patients over 60

22

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

Consider gastric bezoar

23

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

ETEC?

24

Treatment of acute RA exacerbation

NSAIDs

DONT FALL FOR JOINT INJXN

25

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

Sounds like asthma

26

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

Randomized controlled trial of a drug X versus standard therapy?

27

UC association

PRIMARY SCLEROSING CHOLANGITIS

28

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

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

29

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

Probably a putamen hemorrhage

30

Patient with bacterial endocarditis and recently had a dental thing done

Consider Eikenella corrodens

31

First line treatment for pulmonary HTN DUE TO HF

ACEIs and Diuretics

Endothelin-antagonists used for idiopathic pulmonary HTN

32

Tx for complete heart block

Cardiac pacing; regardless of stability

33

Diabetic opthalmoplegia

Causes CNIII palsy with preserved pupillary response

34

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

Likely oropharyngeal dysphagia

GET A VIDEOFLUOROSCOPIC MODIFIED BARIUM SWALLOW

35

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

Consider gastric bezoar

36

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

ETEC?

37

Treatment of acute RA exacerbation

NSAIDs

DONT FALL FOR JOINT INJXN

38

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

Sounds like asthma

39

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

Randomized controlled trial of a drug X versus standard therapy?

40

UC association

PRIMARY SCLEROSING CHOLANGITIS

41

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

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

42

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

Probably a putamen hemorrhage

43

Patient with bacterial endocarditis and recently had a dental thing done

Consider Eikenella corrodens

44

First line treatment for pulmonary HTN DUE TO HF

ACEIs and Diuretics

Endothelin-antagonists used for idiopathic pulmonary HTN

45

Tx for complete heart block

Cardiac pacing; regardless of stability

46

Diabetic opthalmoplegia

Causes CNIII palsy with preserved pupillary response

47

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

Likely oropharyngeal dysphagia

GET A VIDEOFLUOROSCOPIC MODIFIED BARIUM SWALLOW

48

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

Pancreatitis

Patient has had some hemorrhage as well in this case

49

Biggest indicator of a possible heart attack during surgery

History of MI in last 6 months

50

PKD inheritance risk?

Go with 50% yah dingus

51

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

Still need to aspirate to r/o septic arthritis

52

Risk factor screening in HIV pts.

Toxoplasma IgG abs

Hepatitis B surface abs

PPD

53

Felty Syndrome blood levels

PANCYTOPENIA; YOUVE BEEN LIED TO

54

PT with hypotension who is having trouble oxygenating their blood

Consider problem with increased vascular permeability

55

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

ACEI; DONT CARE IF THEIR AIC IS GREAT

56

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

Listen dawg, people aren't that stupid

Weeds caused this rash

She didn't poke herself in the face with a rose thorn

57

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

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

58

Hcrt rule

Hgbx3 = Hcrt

Consider this for RBC transfusion thresholds

59

VZV late lesions

Have little tiny scabs on them ya dingus

Look like black dots

60

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

Lol it's still contact dermatitis yah dingus

61

Vitreous hemorrhage

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

62

Go to test for suspected histoplasmosis

Urine antigen test

Forgo the blood cx

63

Mammogram screening recommendations

Every 2 years from the age of 50-75

64

Hyperlipidemia screening recommendations

Men 35+ every 5 years

65

Pt who develops afib secondary to hyperthyroidism

Treat with a BB