NBME Answers : bluebul's page

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submitted by arnoldchiari(2), visit this page

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Orthopedic, neurological, cardiac, and vascular cases are all "clean" wounds that require abx prophylaxis with cefazolin first line. Alternatives include vancomycin and clindamycin

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bluebul ^this is why every surgery ever starts with the surgeon asking the gas attending for 2g of Ancef. +2

submitted by chris07(69), visit this page

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He's had heat stroke for 2 days???? I get the elevated CK and body temp (all pointing to heatstroke), but the fact that he was a temp of 106 and has been symptomatic for 2 DAYS makes the whole heat stroke diagnosis weird to me.

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drmohandes Exactly my thoughts. -_- +1

bluebul Dude isn't red as a beet. Can't be anti-cholinergic poisoning. +3

submitted by derpymd(20), visit this page

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So we just assume all women of childbearing age are pregnant? I knew amoxicillin is 2nd line treatment, but chose propranolol because I knew stage 2 lyme has cardiac manifestations, I just couldn't remember what they were (AV block, by the way -- improves with antibiotics).

I suppose it's just safer to treat with amoxicillin than doxycycline just in case she's pregnant. ¯\(ツ)/¯

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bluebul I didn't even get that far. Only way to prevent long term complications is with abx and we know metro isn't an option. Leaves only Amox. +4

machetebetty I know that both Sketchy and Divine agree with doxy-except-when-pregnant-or-pediatric, but fwiw, to the extent the CDC is a "source of truth" for the USMLEs, they seem to regard them as equivalent (for this scenario). https://www.cdc.gov/lyme/treatment/index.html ...This also helps me feel less perturbed about the possible [ridiculous] assume-she's-pregnant thing, to @derpymd's point!! +

submitted by step_prep5(246), visit this page

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Young, otherwise healthy man presents with severe flank pain, CVA tenderness and hematuria with pain that is responsive to morphine, most consistent with kidney stone
Key idea: Patients with a kidney stone that is <10 mm and/or not causing urosepsis or renal failure can often be medically managed with hydration, pain control, alpha blockers and straining urine (to look for passage of stone)

https://step-prep.org/tutoring/

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bluebul Also, he probably passed the stone already given that the half life of morphine is 2hrs and his pain subsided 2hrs in. He'd be coming down off the morphine so if he hadn't passed it his pain would be worse. +1

usmile1 Thats a good point bluebul! i didnt notice that. +

link981 @bluebul you can't know for certain if he passed the stone because sometimes stones can cause intermittent pain. Movement can cause the stone to move and cause less obstruction which will temporary relieve the pain, or stone might have moved further down the urinary system to a place causing less obstruction. +