Board Rounds Prep for USMLE and COMLEX

An 18-y/o college freshman presents with increased social anxiety. He wants to make friends but is afraid of being rejected. What's his diagnosis? Links: Full Episode Blog Post BoardVitals Meded Media Follow us on Instagram @mike.natter and @medicalschoolhq

A 36-y/o male presents to the hospital because he fears his heart may be "skipping a beat." His workup and history are normal, so what's causing his symptoms? Links: Full Episode Blog Post BoardVitals Meded Media Follow us on Instagram @mike.natter and @medicalschoolhq

A 15-year-old boy has a history of torturing and killing animals. He has also exhibited violent behavior towards other students at school. What's his diagnosis? Links: Full Episode Blog Post BoardVitals (Use the promo code BOARDROUNDS to save 15% off.) Meded Media The Premed Years 373: From Art School to Med School

A 52-y/o female presents with short, reoccurring episodes of chest tightness, pounding palpations, shortness breath, and severe anxiety. What's her diagnosis? Links: Full Episode Blog Post BoardVitals (promo code BOARDROUNDS and get 15% off) Meded Media

A 20-y/o student presents with anxiety, but her other symptoms suggest her diagnosis may not be so straight-forward. If it isn't GAD, what could it be? Links: Full Episode Blog Post BoardVitals Meded Media Follow us on Instagram at @mike.natter and @medicalschoolhq.

Using our knowledge of cranial nuclei and some spacial awareness, which cranial nerve nuclei receives fibers from the carotid baroreceptors? Let's find out! Links: Full Episode Blog Post BoardVitals (Use the promo code BOARDROUNDS to save 15% off.) Meded Media

More glossopharyngeal neuroanatomy! This gland is innervated by the efferent autonomic fibers of the glossopharyngeal nerve. Name that gland!

Where does the branchial motor component of the glossopharyngeal nerve originate? Join us and see how well you know your neuroanatomy.

Can you accurately identify the various functions of the trigeminal nerve and its major divisions? Follow along to test your knowledge of neuroanatomy! Links: Full Episode Blog Post BoardVitals (Use the promo code BOARDROUNDS to save 15% off.)

A 32-y/o woman with acute cholecystitis has a past medical history of autoimmune hemolytic anemia. Which substance is likely to be found in her gallstones? Links: Full Episode Blog Post Meded Media BoardVitals (Use the promo code BOARDROUNDS to save 15% off.) Follow us on Instagram @MedicalSchoolHQ and @mike.natter.

A 46-y/o female has RUQ pain and distension following surgical repair of a splenic laceration. Which process most likely resulted in her current condition? Links: Full Episode Blog Post Meded Media BoardVitals (promo code BOARDROUNDS and save 15% off)

A 62-year-old female presents with impared taste and drooping on the right side of her face, but her hearing is normal. Where is the probable lesion located? Links: Full Episode Blog Post BoardVitals (Use the promo code BOARDROUNDS to save 15% off) Follow us on Instagram @medicalschoolhq and @mike.natter.

A 28-y/o female presents with a painful, lower-abdominal mass two days after a c-section. What is the most likely site of injury that led to this hematoma? Links: Full Episode Blog Post BoardVitals (promo code BOARDROUNDS to save 15% off) Meded Media

A 70-y/o male has hypoesthesia of the trunk, hypoalgesia, and decreased temperature discrimination. Which diagnosis accounts for residual pallesthesia and fine touch? Links: Full Episode Blog Post Meded Media BoardVitals (promo code BOARDROUNDS and save 15% off) PMY 373: From Art School to Med School with Dr. Mike Natter Follow me on Instagram @medicalschoolHQ. Follow Dr. Mike Natter on Instagram @mike.natter and check out all his amazing artwork.

A 52-year-old female with renal failure has perioral numbness, paresthesias of the hands and feet, and muscle cramps. What metabolic findings might we expect? Links: Full Episode Blog Post Meded Media BoardVitals (Save 15% by using the promo code BOARDROUNDS.)

What does this patient's decreased creatnine clearance and oliguria tell you? What risk factors are behind his condition? Would you give him contrast dye?

This adult female with persistent fatigue complains of feeling cold. Listen to the lab values and look at the image in the show notes. What is the etiology? Links: Full Episode Blog Post BoardVitals (promo code BOARDROUNDS to save 15% off) Connect with Dr. Mike Natter on Instagram @mike.natter.

Infectious Disease! A young man presents with increasing SOB and green sputum. Sputum culture shows α-hemolytic gram positive cocci in chains. Name that bug! Links: Full Episode Blog Post Meded Media BoardVitals (Use the promo code BOARDROUNDS and get 15% off.) Follow Dr. Mike Natter on Instagram @mike.natter.

A patient with a DVT has not been using his heparin, and now he's back with LLE weakness. What are his heart sounds, cranial MRI, and history revealing? Links: Full Episode Blog Post Meded Media BoardVitals (Use the promo code BOARDROUNDS to save 15% off.) Follow Dr. Mike Natter and his amazing artwork on Instagram @mike.natter

Session 33 This middle-aged male has hypertension and diabetes. Which cardiac abnormality is giving rise to his radiating, high-pitched, holosystolic murmur? We’re joined by Dr. Mike Natter from BoardVitals. Go check out his amazing artwork on Instagram @mike.natter. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [02:30] Question of the Week A 58-year-old male is presenting for an evaluation of a heart murmur that was recently discovered at a work health fair. His past medical history is remarkable for hypertension and diabetes. He has a nice chest pain, palpitations, syncope, or dyspnea. Cardiac auscultation reveals a high-pitched, blowing, holocystolic murmur at the apex. It radiates toward the axilla. The murmur does not increase in intensity with inspiration. What is the most likely diagnosis? (A) Mitral stenosis (B) Ventricular septal defect (C) Tricuspid regurgitation (D) Aortic stenosis (E) Mitral regurgitation [Related episode: USMLE and COMLEX Prep: 60 y/o Male with a Murmur] [03:43] Definition of Terms Holosystolic means you hear the sound throughout systole. It's not going away at any point, increasing or decreasing. It's just going. The apex of the heart is the opposite of the base. It can be sometimes confusing for medical students because it's almost the opposite of what you look at when you're looking at the heart. So the apex of the heart is located at the bottom. It's the inferior part of the heart. [06:17] The Correct Answer and the Thought Process Behind It If it's holosystolic, it's the systole. The ventricles are contracting. So what we're hearing is blood flowing back. It's the regurgitation through either the tricuspid or the mitral valve. Typically, where you're hearing the sound is the blood coming at you. So I'm narrowing my choices here down to either (C) Tricuspid regurgitation or (E) Mitral regurgitation. Mike points out that it's a good test-taking strategy to narrow down your choices. In this case, the correct answer is E. You want to look at pitch, location, and timing. You can grade murmurs and where it radiates, etc. Based on what's going on, we're dealing with a regurgitating murmur.  The murmur of mitral regurgitation gives you this blowing holosystolic sound and radiating to the axilla. It's a pathognomonic mitral regurgitant's description. So anytime you hear that description, it's telling of a mitral regurgitant murmur. It's essential to memorize the patterns because once that's done, you'll get those points easy. [12:08] Understanding the Other Answer Choices Mitral stenosis is characterized by more turbulent flows. Blood is trying to push through something that's basically closed. With stenosis, imagine the blood is knocking at the door and you hear a very hard clunk, clunk, clunk. It's very different from a blowing murmur or regurgitant-type murmur which sounds like a "woosh, woosh, woosh." Ventricular septal defect (VSD) is a defect between the two ventricles. What happens here is that blood is going to go from high pressure to low pressure. It sounds like a train going over a bridge "chug, chug, chug." In this condition, you're going to have the blood going from the left ventricle into the right ventricle. You will hear that extra sound in the heart as well. You could hear this on the bicuspid area although it's also going to be a holosystolic murmur. In...