NBME Medicine Shelf Review Session 1 - WordPress

NBME Medicine Shelf ReviewSession 1Some MS4

Introduction-This first review set contains 70 keyword slides.-The goal would be to spend 90s or less per slide (some will take 30s).-Strongly encourage making notes with each slide. Study these notes for your shelf.Writing stuff down will help tremendously with retention.-Designed to be a more comprehensive but HY medicine shelf review.-Make sure you do all 4 practice NBMEs for the medicine shelf. If a topic is completelynew to you, spend about 10 mins studying that topic as something similar may betested on the shelf.-The medicine shelf is surprisingly not a huge departure from a lot of the materialtested from the organ systems on Step 1. We will review some of this pertinent stuff.

1Opening snap with diastolic rumble at left 4thinterspace. Tall jugular venous A waves. How canwe increase the intensity of this murmur?

2Elevated AST/ALT, blistering lesions on the dorsumof the hands, severe hirsutism. What is the enzymedeficiency? How is this disease treated?

3Hypoglycemia, hypoglycemic sxs, resolution withglucose administration. Differentiating 3 big causesof hypoglycemia based on labs. The acute treatmentof hypoglycemia.

4A Diarrhea (Bugs, associations, treatment)Pork consumption, Undercooked shellfish, Severerice-water stools in a developing country, Bloodydiarrhea with a super small inoculum, Bloodydiarrhea after consuming eggs/poultry, Waterydiarrhea 2 hrs after consuming potato salad, Bloodydiarrhea with low plts/unconjugatedhyperbilirubinemia/elevated creatinine.

4B Diarrhea (Bugs, associations, treatment)Diarrhea upon return to the US from Mexico, Foulsmelling watery diarrhea after recent treatment foran anaerobic bacterial pneumonia, Crampyabdominal pain after consumption of home cannedveggies, Bloody diarrhea with ascending paralysis ina puppy owner, Watery diarrhea after eating friedrice at a Chinese restaurant.

5Prussian blue staining of a bone marrow smearreveals basophilic inclusions around the nucleus ina 75 yo M that lives in a home built in the 1930s.What are the associated Fe lab values? How is thisdisease treated ( potentially helpful vitaminsupplementation)?

6CXR showing diffuse, bilateral, ground glassinfiltrates in a febrile patient taking high doseimmunosuppressants. What is the bug? Relevantstain? Prophylaxis? Treatment? Who should getconcomitant steroids? Diagnostic studies?Classically elevated marker from pulmonary fluid?

7 (Associations/Relevant Bugs/Risk factors)Flank pain with gross hematuria. Envelope shaped?Coffin shaped? Radiolucent? Shaped like a hexagon?What is the best diagnostic testing modality? Howis this presentation treated?

824 yo M presents with a painless, palpable bonymass on the left knee. Knee X ray reveals acontiguous mushroom shaped mass. What is thediagnosis?

966 yo F is found unconscious at home by herdaughter in December. PE is notable for a cherryred appearance of the skin. Next best step indiagnosis? Treatment modalities? Pathophysiologyand O2 delivery associations? Classic exampresentation and risk factors?

10Elevated creatinine 24 hrs after getting a CT scan.How could this have been prevented? Skin fibrosisafter getting a brain MRI. Is there a particular DMmedication that should be held before getting a CTscan?

11A common lower extremity side effect associatedwith hydralazine and Ca channel blockers. What isthe pathophysiology? How is this condition treated?What is the pathophysiologic mechanism?

12HIV patient with a 3 day history of fever presentswith targetoid skin lesions, lip/mouth ulcerations,and visual impairment. PE is notable for skinsloughing (8% BSA). Nikolsky sign is ve. He wasplaced on Allopurinol 10 days ago for chronic gout.What is your diagnosis? 30% BSA involvement?

1330 yo F presents with 3 day hx of polydipsia andpolyuria. Blood glucose is 650 mg/dl, Bicarb is 21,pH is 7.35. Diagnosis? Pathophysiology? Riskfactors? Treatment? Na balance? K balance? What isyour dx if the patient becomes altered/comatosewith rapid treatment?

1449 yo F presents with wheezing and flushing. PE is ve for murmurs consistent with tricuspidregurgitation and pulmonic stenosis. Diagnosis?Diagnostic steps? Treatment (pharmacology)?Symptoms by location? Pellagra?

1561 yo M presents with exertional dyspnea. CBC isnotable for a Hct of 27%. What is the next best stepin management? What would Fe studies dictate?What is our primary concern? When shouldtransfusion be explored? What would yourdiagnosis be if the patient had a similarpresentation and difficulty swallowing?

1629 yo F with a recent trip to India (ate local foods).Returned 2 weeks ago and initially had fevers for 1week. Now presents with severe abdominal painand distension. PE is notable for salmon coloredcircular lesions on the trunk. Diagnosis? Treatment?

17Septic arthritis - what is the bug? ( most commoncause, in a sickle cell patient, in a young F withpurpuric skin lesions). Diagnostic step? Findingsfrom diagnostic steps? Treatment (2 prongedapproach). The Neisseria vs Chlamydia treatmentdifference.

18Subconjunctival hemorrhage in a patient with nastycoughing episodes. Diagnosis? Treatment?Prophylaxis for close contacts? What would thenext step in management be in a person thatrecently started Ramipril for the treatment of HTNwho has a cough?

19Reviewing first, second, and third degree AV blocks.Acute management in a symptomatic patient?Contraindicated medications? Who gets apacemaker?

20Reduced EF in a patient with coarse facial featuresand enlarging fingers. Diagnosis? Diagnostic steps(3)? Treatment options? Most common cause ofdeath?

21Dysphagia to solids and liquids in a patient withthick/thin blood smears (Giemsa) revealing whatappears to be motile parasites. Diagnosis?Diagnostic steps (2)? Pathophysiology?Surgical/Non-Surgical treatment options? Potentialsequelae of treatment/disease sequelae?

22Reduced MCV in a patient with a long history ofuntreated rheumatoid arthritis. Diagnosis? Whatwould the results of a CBC/Fe studies indicate?Pathophysiology?

2325 yo M with nasal packing presents with a BP of65/40, elevated Cr, respiratory distress, T of 104, andmarginally elevated troponins. Diagnosis?Pathophysiology? Classic bug associations (2)?Treatment strategies?

24Sequelae of CKD (acid-base anomalies, electrolyteanomalies, hematologic anomalies, Ca and Pbalance). Consequences of uremia. Management ofCKD (drugs, electrolyte/hematologic fixes). How iskidney function preserved in DKD? Indications fordialysis.

25Rb gene mutations, Paget’s disease, andTeriparatide administration increase risk of whatprimary bone malignancy? Associated radiologicalfeatures?

26Aspirin Exacerbated Respiratory Disease. Potentialpathophysiology? Classic presentation? Treatment

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28Aspirin Exacerbated Respiratory Disease. Potentialpathophysiology? Classic presentation? Treatment

29Classic EKG presentation of a SupraventricularTachycardia. Stepwise management of an SVT.What is the next best step in management if apatient has an SVT but is hemodynamicallyunstable? What is the most common EKG findingin a patient having a pulmonary embolus?

3018 yo F presents with scaly, erythematous upperextremity lesions. She has a long history of allergicrhinitis. What is your diagnosis? How is this treated?What would your diagnosis be if these lesions alsohad umbilicated vesicles? How would this betreated? What is the classic CBC finding with thesediagnoses?

31A patient presents with the classic “stones, bones,groans, and psychic overtones”. PE is notable forskin tenting. What is the FIRST step inmanagement? A quick overview of Capharmacology.

32Testing modalities for H. Pylori infection (3). Tripletherapy. Classic presentation/risk factors for pepticulcer disease.

33Alpha vs Beta Thalassemias. Pathophysiology.Compare and contrast (C/C) beta vs alphathalassemia minor in terms of Hb electrophoresisresults. C/C beta vs alpha thalassemia major interms of presentation onset and Hb electrophoresisresults. What is Hb H disease? What is Hb Barts?What is the classic smear finding in thalassemias?

34Classic CBC findings in hemolytic anemias. Classic“gallbladder” pathology present in patients withhemolytic anemias. These patients are at risk ofaplastic crises with what bug? Do thalassemiaspresent as a microcytic, normocytic, or macrocyticanemia?

3523 yo M who recently returned from Tucsonpresents with a 2 week history of fever, ankle/kneepain, chest pain, and a painful, erythematouspretibial lesion. Diagnosis? Classic finding onmicroscopy? Treatment strategy? Classicgeographical association.

36Periorbital edema, hematuria, and HTN in a patientwith a recent history of cellulitis. BUN and Cr areelevated. Diagnosis? Pathophysiology? Associatedantibodies? This disease reflects what kind ofhypersensitivity reaction?

3711:22 translocation, X-Ray imaging reveals an“onion skin like” periosteal reaction, bone biopsywith histology reveals small, round, blue cells. Whatis your diagnosis?

38What is a parapneumonic effusion (PNE)? Describethe following- Uncomplicated PNE, ComplicatedPNE, Empyema. What are the pH, LDH, glucose,and micro criteria that typify a “high risk” PNE?How do the available treatment modalities help youdifferentiate between the different parapneumoniceffusion types?

For Keyword 39 (next slide)

39What is your diagnosis? How would you describethe rhythm? How would treat this rhythm in apatient that is stable/asymptomatic vs a patient thatis hemodynamically unstable vs a patient that lacksa pulse? What is the most common cause of deathin the immediate period following an MI?

40Oral mucosal ulcerations ve Nikolsky sign(flaccid skin blisters) in a 45 yo M. Diagnosis?Pathophysiology? Type of hypersensitivity reaction?Diagnostic testing modality (super HY)? Treatmentstrategy?

41Lab differentiation between primary and secondaryhyperaldosteronism. Screening vs confirmatorytesting for Conn Syndrome. Causes of secondaryhyperaldosteronism. Treatment strategies withConn Syndrome. Quick description of nephronphysiology.

42The Rome Criteria for Irritable Bowel Syndrome.Classic patient demographic. Are there lababnormalities? IBS Classification.

43Cold vs Warm Agglutinins (classic antibodies, bugassociations). Treatment differences b/w warm andcold agglutinin disease. LDH, Bilirubin, andHaptoglobin levels in hemolytic anemia.

4432 yo Egyptian immigrant presents with a 2 weekhistory of abdominal pain, hepatosplenomegaly,and hematuria. He swam in The Nile 2 months ago.Diagnosis? Bug? Route of transmission? ClassicCBC observation? Potential oncologic sequelae?Pharmacological management?

45Synpharyngitic glomerulonephritis. Compare andcontrast with Post Infectious Glomerulonephritiswrt to- Timeline to onset of symptoms,complement levels, etc. Treatment strategies. Classicurine findings with the nephritic syndromes.

4670 yo M with leg pain that is worsened by a backheld in extension (but better when held in flexion).Diagnosis? Diagnostic testing? Treatment strategies?

47Opening snap with a diastolic rumble heard best inthe 4th intercostal space in the midclavicular line.Diagnosis? #1 risk factor? Diagnostic testing?Treatment strategies?

48No oral mucosal lesions Pruritus NegativeNikolsky sign. Diagnosis? Pathophysiology? Bestdiagnostic test? Treatment strategies (contrast withinitial management of the somewhat analogousNikolsky ve disease)?

49Compare and contrast primary and secondaryadrenal insufficiency (by classic cause, skin findings,levels of ACTH/Aldosterone/Renin, Cosyntropintesting, treatment strategy). Key labs/CBC findingsin AI. AI with a history of nuchal rigidity andpurpuric skin lesions. Discussion of adrenalphysiology. Stress Steroid Dosing.

5069 yo M with fever, leukocytosis, and LLQ pain.Diagnosis? Pathophysiology? Diagnostic testing?Contraindicated initial studies? GI Antibioticstrategies on the NBME (2)? What is your diagnosisif this patient presents weeks later with recurrentUTIs with urinalysis revealing air and fecalmaterial?

-Designed to be a more comprehensive but HY medicine shelf review.-Make sure you do all 4 practice NBMEs for the medicine shelf. If a topic is completely new to you, spend about 10 mins studying that topic as something similar may be tested on the shelf.-The medicine shelf is surprisingly not a huge departure from a lot of the material