National Board of Medical Examiners

The scan on the right is our patient.

NBME will show you these images.

You're expected to know what they are.

What's most likely to be seen as a patient? Should I say anti-centrum antibody is fucking wrong? It refers to limited scleroderma, a.k.a.

Now let's look at pile two, right? People that are at risk that should get screened, right? So head B is pretty high yield to know that adolescents, right? Adults at increased risk, they should get screened, right? So notice these are the people at risk, right? That's a grade B recommendation, right? So what are the big ones? Well, if you were born in a country where the prevalence of HIV is like 2% or higher, or you're US born, but you were not vaccinated as an infant, right? And you have parents from like a high prevalence region, right? Or you're HIV person, right? Or you're an IV drug user, or men that have sex with men, right? Or household contacts, sexual contacts of people that have Hep B, right? Again, these are all high-risk folks, right? They are all high-risk, right? So again, born in a country where Hep B prevalence is 2% or higher, you were born in the U.S., not vaccinated as an infant, right? And your parents are from a high Hep B prevalence region, right? HIV drug users, men that have sex with men, household contacts or sexual contacts of people that have Hep B, right? Those people should get screened, right? And remember also, again, pregnant patients, right? Every person that is pregnant at the first prenatal visit got to get screened for Hep B.

So you're seeing like we're building that pregnancy list, Hep B, Hep C, HIV, right? And the test you pick on your exams is the Hep B surface antigen, right? The thing is, our friends at the NBMEs, they have this nasty habit, right? of giving you many different hair B serologies to pick one as the screener.

Pick the hair B surface antigen.

You know why? Because if your hair B surface antigen is negative, you don't have hair B.

Quite difficult.

So this is what NBME will do is sometimes they'll give you a past-level vignette.

But the question's hard.

So easy times difficult, or they can flip it.

Hello and welcome to episode 63 of the High Yield Family Medicine Podcast.

In this episode, we're going to be doing an overview of some of the most high yield things you need to know for the NBME as it pertains to blood thinners.

We'll be going over all of the main players today, including antiplatelets like aspirin and clopidogrel, oral anticoagulants like apixaban and warfarin, and injectables like heparin and anoxaparin.

For each, we'll be talking about how the medication works, when to use it, and some key considerations that you need to know which love to show up on the exam.

That could be grizzly of fulvin, microtubules.

I had seen a question way back on one of the old NBME forums where they gave you some obscure image similar to this.

And apparently this is referring to the microtubules.

Even if you didn't know, you can just say, well, what antifungal drugs do I know of, period? We haven't talked about grizzly of fulvin yet.

PAP every three, HPV alone every five, or HPV, like PAP smear plus HPV co-testing every five years, right? Every five years, right? Every five years.

Now, if for some bizarre reason, our friends at the NBMEs give you all three options, you for an age 30 to 65 female and they ask you to pick and they are wanting you to pick one specifically pick the one where you do HPV alone every five years that is the preferred method in the 30 to 65 age group but all three of those methods are perfectly fine now Once you hit 65 and you've had adequate prior negative screening, you know, like the last couple of years, usually like 10 or thereabouts, you can stop screening then.

You can stop screening then.

That's a great recommendation.

This is one of the hereditary causes of SLE.

And NBME asks it.

It's the first time you're hearing it.

Sounds very weird.

This is gonococcus, disseminated gonococcemia.

The image on the left, we have gram-negative diplococci.

If you didn't know what you were looking at, you're like, well, how the fuck am I supposed to see that? This is the type of image NBME will show you.

So if you were to see these types of answers and you see cutaneous papules, you just know, okay, I see two little dots close together.

Well, that's cool because we don't need to know the image to get it right.

NBME will do this sometimes.

They'll give you an image, but we can answer it based on this one and a half liner alone.

What's most likely to be seen in this patient? Choice A, blood glucose 440, which of course would insinuate diabetic retinopathy.

All right.

So the first class is the NBME Test-Taking Strategies class.

This class is for Step 1 to 3, and it's for shelf exams, right? So let's start with the one that will basically help you with every single exam that you will ever sit for, right? This class is a two-and-a-half-hour class, and it's all about method.

Literally, I teach you how to take tests, right? We work through a range of questions, and, you know, we, we, we basically build up a repeatable approach, you know, for avoiding classic NBME traps, pulling out what matters from a long question stem, right? The question stems are very long these days.

Breaking down 50/50 situations, right? When you're stuck between two answers.

Handling ethics questions, right? And honestly, like, this is actually kind of a, a b- a big one, right? Like, being able to answer questions on material you may not even know particularly well, right? Because the thing is, on test day, there will be questions you don't know.

This class teaches you how to think about biostats and epi, right? The thing is, many people, they, they walk out realizing that, "Wait, most of these formulas that people memorize, I don't even need them." To be honest with you, when I took all my USMLE exams, I didn't write any biostats formula.

Like, why should I do that? Most of biostatistics is reasoning, right? Once you understand what the numbers are actually doing, you know, the questions, they, they stop becoming calculations to you.