1) Gluten intolerance + rash = Dermatitis herpetiformis Dx: Skin biopsy Tx: Dapsone

2) Athlete twisted knee in football game with +McMurray test = Meniscus tear Confirmatory Dx = MRI (recall: NBME love testing that MRI are test of choice for osteomyelitis! Xrays are relatively lower sensitivity but are appropriate first line imaging for both)

3) Healthy 55yo M w/ family history of thyroid cancer, concerned about risk of thyroid cancer. Screening test = palpate thyroid gland for nodules **Test-taking tip: Don't fall for thyroid U/S just because the question asks for screening test! Start with LEAST INVASIVE OPTION

4) 20yo with cough, worse in the cold. NORMAL Spirometry. Dx? Asthma! In healthy patients, the spirometry is usually normal unless having exacerbation. Next step: Methacholine challenge test **Tested on NBME: An improvement in FEV1 by 12% and 200 ml with albuterol = asthma!

5) If you see vocal cord polyp --> answer is OFTEN HPV infection Dx: Laryngoscopy Tx: surgical excision + cidofovir (watch for nephrotoxicity)

6) Male with progressive visual impairment & CD4 < 50 = CMV retinitis Tx: Ganciclovir, foscarnet or cidofovir

7) Patient with Alzheimers + Sinus Bradycardia --> tx: Memantine (NMDA antagonist that IMPROVES neuroprotection) Note: You wouldn't give donepezil or rivastigmine (cholinesterase inhibitors) in AV Block or bradycardia due to s/e of bradycardia!

8) Patient with forgetfulness over last few months and SEVERE depression = Pseudodementia Tx: sertraline or other antidepressant (vortioxetine has anticholinergic effects so may be beneficial!)

9) 70yo with painful & decreased ROM shoulders and hip flexors + temp of 100F = Polymyalgia Rheumatica Mnemonic: P.M.R. = Painful Motion Restricted Next best step: Prednisone x1-2 years HY Assoc: PMR + new onset vision loss = Giant Cell Arteritis Dx: ESR + Temporal artery bx

9a) If patient has HIGH suspicion for Giant Cell Arteritis, what is the NEXT BEST STEP? --> STEROIDS! Don't wait for biopsy! Us vascular surgeons sometimes take a lil while to get them to the OR, so get the steroids in ASAP!!!

9b) HY Reminders for vasculitis -40yo F with weak radial pulses = Takayasu -Conjunctivitis + swollen hands + fever = kawASAki, give ASA & IVIG (WATCH FOR CORONARY ARTERY ANEURYSMS) - Child w/ URI + palpable purpura + mild Intussusception = HSP (no tx generally needed)

9c) HY Vasculitis cont. - Hep C + Raynauds + periph neuropathy/palpable purpura/weakness (Melzer's Triad) = Mixed Cryoglobulinemia Syndrome - P-ANCA + allergic rhinitis = Churg-Strauss aka eosinophilic granulomatosis with polyangiitis -No ANCA , no lung dz, + Hepatitis = PAN

10) Carpal Tunnel next best step = Wrist splints

11) Vesicles on the NBME should clue you in to herpes viruses in MANY questions! Ex: Patient with atopic dermatitis + new vesicles = eczema herpeticum Tx for eczema herpeticum: acyclovir Tx for atopic dermatitis algo: moisturizer--> topical steroid--> tacrolimus -->UV light tx

12) Med student with constipation predominantly (occasional diarrhea) before each exam = IBS --> next step: try fiber supplement (psyllium)

13) HTN + Migraine = best prophylaxis is B-blocker (kill 2 birds w/ one stone)

14) Patient with NORMAL BMI + increased serum total cholesterol & normal LDL--> next best step = Exercise program -kinda counterintuitive, but it's the NBME, what can I tell ya ;)

15) Test taking tip: If the NBME goes out of their way to write out EVERY medication a patient is taking: Look for answer choices that reflect side effects/polypharmacy OR conditions associated with the med such as: drug-induced esophagitis, SJS, aplastic anemia etc.

16) Diabetic neuropathy algo: Gabapentin --> if failed gaba/pregabalin, try TCA (nortriptyline) Next best step: examine feet for diabetic foot ulcers

17) PCKD + HTN = Lisinopril HY Assoc: -MVP (mid-systolic click + crescendo) -Diverticulosis -intracranial aneurysms (if AComm = bitemporal hemianopsia, if PComm = ipsilateral CN3 palsy) HY Assoc: ARPKD w/ Caroli disease = dilatation of bile ducts, liver cyst, w/ gallstones

18) 🫁🫁🫁 Mycoplasma = healthy pt w/ crackles. Assoc w/ cold agglutinin hemolytic anemia, erythema multiforme, AIN. NOTHING on Gram stain (chol. membrane) Legionella = charcoal yeast agar Chlamydophila = Reticulate body on Giemsa. Assoc w/ erythema nodosum & Guillain Barre

19) Most SENSITIVE test for diabetes = 2-hr glucose tolerance test > 200 (only need a random glucose > 200 + symptoms to diagnose DM tho!

20) 2 Most commonly tested conditions with Charcot Joint = severe diabetes w/ neuropathy & syphilis

21) Recurrent stabbing chest pain + elevated CK + flu-like sx's = Coxsackievirus pleurodynia (Bornholm dz) Tx: NSAID Note: Coxsackie can cause Dilated Cardiomyopathy & Acute Pericarditis too!

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Here’s the review guide with a ton more TQ’s https://youtu.be/92wbZP6dbFs

@action_ap Great work Doc!!

@jparkash308 Thanks friend!

@action_ap Seriously amazing. Thank you!!!

@SanjoliMed For sure! Check out the video for a deep dive on some of the topics! I hope it’s helpful :)

@action_ap Thank you King 🤴

@DOCNOSCRUBS I got you G!!