#nbme

As I understand it, CS is going virtual for this year.

COMLEX PE is still set to happen in person, and originally was going to stay on schedule to start in July. Then I read they are thinking about delaying it until the fall.

Well, you guys have probably put the pieces together already but here’s the problem:

-PE is only done in two cities

-In most cases, a passing mark is used as a gatekeeper for getting residency interviews

-Even on a regular July schedule, only a limited number of slots are available

Students have been expressing concern to me about this shitstorm of circumstances and how it’s going to impact their match. Meanwhile, the NBOME has been providing very little in the way of updates and transparency. This test is $1300 per student per attempt AND plays a factor in their career prospects.

DOs, I think we should be hassling the NBOME and maybe the AOA. A few people started doing this on IG and the NBOME locked down their posts/deleted comments. Students deserve so much better.

Topics Covered: - Epiglottitis

- Croup

- Bronchiolitis

- Foreign Body Aspiration

- Vascular Ring

- Pneumonia

Pre-reading Quiz:

1. Stridor is heard during ________ (inspiration/expiration), whereas wheezing is heard during ________ (inspiration/expiration).

2. Treatment of ____________ is nebulized racemic epinephrine + dexamethasone.

3. CXR for __________ will show unilateral hyperinflation +/- tracheal deviation to the opposite side.

Epiglottitis

What: bacterial infection of epiglottis w/ Hib, GAS, S. pneumo, S. Aureus

Why: hematogenous spread, unvaccinated (Hib)

Treatment: Ceftriaxone + Vancomycin, Endotracheal intubation

Buzzwords 

tripod positioning

drooling, distress, dysphagia

Croup (Laryngotracheal bronchitis)

What: Parainfluenza virus >> RSV

Why: Hemagluttinin permits viral entry, Neuramidinase permits spread.

Sx: Prodromal phase w/ rhinitis/congestion, then cough in late evening

Treatment: 

Nebulized Racemic epinephrine

Dexamethasone

Humidified air

Heliox decreases work of breathing

Buzzwords:

Barky cough worse at night

Inspiratory stridor

Bronchiolitis

What: RSV in patient less than 2 years old

Why: viral infection and inflammation of bronchioles

Sx: Prodrome phase w/ rhinitis/congestion, then cough/wheezing/crackles and respiratory distress

Treatment:

Nasal suctioning

Supplemental oxygen

HFNC, CPAP

Albuterol/epinephrine, Corticosteroids if severe

Palivizumab monthly during RSV season for first year of life if (premature <29 weeks, heart/lung disease, immunocompromised)

Buzzwords

URTI > Respiratory distress

Foreign Body aspiration

What: acute onset SOB due to foreign body in airway

Treatment:

Rigid bronchoscopy

Buzzwords

Sudden onset SOB

Hyperinflation + mediastinal shift

Decreased breath sounds

Vascular Ring

What: congenital aberrant branch of aorta encircling esophagus/trachea

Sx: Inspiratory and Expiratory stridor w/ history of noisy breathing since birth OR dysphagia to solids

Dx: CTA

Buzzwords

Biphasic stridor

Worsens with crying/feeding

Improves w/ neck extension

Pre-reading Quiz Answers:

1. Stridor is heard during ________ (inspiration/expiration), whereas wheezing is heard during ________ (inspiration/expiration).

2. Treatment of _Croup_ is nebulized racemic epinephrine + dexamethasone.