NBMEs Flashcards
Important indicator for anticoagulation
Prosthetic heart valves
Pt who has a skin rash that resolve but then has it again in two different locations
Probably an autoinfection
Patient with CD4 count of >500 and viral load of 2000 or less
Do not start on antiretroviral therapy
Tx of patient with unstable AV dissociation
DC cardioversion
Young patient with swollen cervical lymph nodes and systemic B sx.
Hodgkin lymphoma
Patient who has an obstructive pneumonia due to stage IV cancer but denies any further chemo
Send home with hospice care
Best way to prevent hypertensive strokes in the future
Lisinopril therapy
Pt with history of heartburn who progressively has trouble swallowing solids
Get an upper endoscopy
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
Female woman who has dilated intrahepatic ducts, epigastric pain, and increased direct bilirubin
Choledocholithiasis
Causing pancreatitis as well if there is epigastric pain
Crescendo-decrescendo murmur along the left sternal border w/ carotid radiation
HCOM
Serotonin syndrome presentation
AMS
Autonomic instability
Neuromuscular excitability (tremor, hyperreflexia, myoclonus)
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
Gift accepting from pharmaceuticals
Small gifts that MUST DIRECTLY BENEFIT PATIENT
Otosclerosis pt
Can be a young female
Tx with hearing aids
Complication of viral myocarditis
Dilated cardiomyopathy
Echo shows dilated ventricles with diffuse hypokinesia =» decreased EF
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
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
COPD pt who doesn’t respond to normal treatments
Start NONINVASIVE positive-pressure ventilation
Decreases RR and PaCO2
VZV is contagious when…
Open vesicles are present
IC
Never had chickenpox
VZV vaccination recommendation ion
All patients over 60
Pt with mental retardation and has increasing episodes of vomiting after eating and has weight loss
Consider gastric bezoar
Pt who has history of travel, abdominal bloating, increasing flatulence, and diarrhea that is non-blood and foul smelling
ETEC?
Treatment of acute RA exacerbation
NSAIDs
DONT FALL FOR JOINT INJXN
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
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?
UC association
PRIMARY SCLEROSING CHOLANGITIS
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
If a patient has deviation of the eyes towards one side after a stroke
Probably a putamen hemorrhage
Patient with bacterial endocarditis and recently had a dental thing done
Consider Eikenella corrodens
First line treatment for pulmonary HTN DUE TO HF
ACEIs and Diuretics
Endothelin-antagonists used for idiopathic pulmonary HTN
Tx for complete heart block
Cardiac pacing; regardless of stability
Diabetic opthalmoplegia
Causes CNIII palsy with preserved pupillary response
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
Pt with mental retardation and has increasing episodes of vomiting after eating and has weight loss
Consider gastric bezoar
Pt who has history of travel, abdominal bloating, increasing flatulence, and diarrhea that is non-blood and foul smelling
ETEC?
Treatment of acute RA exacerbation
NSAIDs
DONT FALL FOR JOINT INJXN
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
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?
UC association
PRIMARY SCLEROSING CHOLANGITIS
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
If a patient has deviation of the eyes towards one side after a stroke
Probably a putamen hemorrhage
Patient with bacterial endocarditis and recently had a dental thing done
Consider Eikenella corrodens
First line treatment for pulmonary HTN DUE TO HF
ACEIs and Diuretics
Endothelin-antagonists used for idiopathic pulmonary HTN
Tx for complete heart block
Cardiac pacing; regardless of stability
Diabetic opthalmoplegia
Causes CNIII palsy with preserved pupillary response
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
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
Biggest indicator of a possible heart attack during surgery
History of MI in last 6 months
PKD inheritance risk?
Go with 50% yah dingus
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
Risk factor screening in HIV pts.
Toxoplasma IgG abs
Hepatitis B surface abs
PPD
Felty Syndrome blood levels
PANCYTOPENIA; YOUVE BEEN LIED TO
PT with hypotension who is having trouble oxygenating their blood
Consider problem with increased vascular permeability
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
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
Do pts. with Klinefelter’s need to be retarded?
Nope; this sucks because that’s usually a give away
Hcrt rule
Hgbx3 = Hcrt
Consider this for RBC transfusion thresholds
VZV late lesions
Have little tiny scabs on them ya dingus
Look like black dots
Culture of a lesion that looks like contact dermatitis but grows CNS
Lol it’s still contact dermatitis yah dingus
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
Go to test for suspected histoplasmosis
Urine antigen test
Forgo the blood cx
Mammogram screening recommendations
Every 2 years from the age of 50-75
Hyperlipidemia screening recommendations
Men 35+ every 5 years
Pt who develops afib secondary to hyperthyroidism
Treat with a BB
