StudyXing Medicine @USMLEStepStudy Twitter profile

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StudyXing Medicine

@USMLEStepStudy

2 years

Cerebral hemorrhages

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1 year

Antidotes for _________ toxicity/overdose:

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11 months

Appendicitis = RLQ tenderness + 1 or more pos. low sensitivity tests/signs: – Rovsings: RLQ pain w/ LLQ palpation – McBurneys: tenderness ~2" from ASIS (on line to umbilicus) – Psoas: RLQ pain w/ passive right hip ext – Obturators: RLQ pain w/ R hip/knee flexion + hip rotation

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6 months

Diuretics and where they work

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2 years

Congenital rubella infection (CRI) = deafness, cataracts, glaucoma, cardiac dz (PDA), CNS abnormalities (microcephaly), fetal growth restriction, petechiae and purpura (“blueberry muffin lesions”)

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2 years

Ramsay Hunt syndrome: unilateral facial nerve paralysis & ear (oticus) / mouth vesicular rash via varicella zoster virus; s/s: tinnitus, sensorineural hearing loss, weak smile / forehead / eyelid closure, slurred speech, hyperacusis, N/V, vertigo, taste loss, dry mouth & eyes

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8 months

Gram positive bacteria: 1. Bacilli 2. Cocci (MC) 3. Filamentous

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2 years

Pleural effusion = excess fluid outside lungs (in pleural space) Transudate = transient → chgs in hydrostatic pressure: cirrhosis, CHF, nephrotic syndrome, ascites, hypoalbuminemia Exudative = protein↑, LDH↑: infection, malignancy, immune; MC cause = pneumonia, cancer, PE, TB

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2 years

CXR Patterns: lobar vs diffuse pneumonias

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1 year

Retroperitoneal structures = "SAD PUCKER" -Suprarenal (Adrenal) gland -Aorta and IVC -Duodenum, 2nd & 3rd part -Pancreas -Ureter -Colon, ascend/descending -Kidney -Esophagus -Rectum

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1 year

Finger clubbing: Path - Increased capillary density; Release of platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF) from megakaryocytes (enhanced by hypoxia/hypoxemia) --> increased vascularity, permeability --> connective tissue density changes

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2 years

Ovarian tumors

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2 years

Apgar score describes a neonate's cardiorespiratory and neurologic condition. The score is not a tool to guide resuscitation or subsequent treatment and does not determine the prognosis of an individual patient.

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2 years

Acute disseminated intravascular coagulation (DIC): overt bleeding/bruising, low platelet count, prolonged PT and PTT, high fibrin degradation products --> activation of coagulation, leading to microvascular thrombi

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2 years

Abdominal quadrant pain is mostly about anatomical correlation and can provide cues and clues to working diagnosis

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2 years

Ankle inversion/reversion muscles action (2nd letter —> E for eversion, I for inversion)

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2 years

EKG/ECG anatomical, coronary artery, correlation

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2 years

Moderate to severe benign prostatic hyperplasia is best treated with dual therapy: a 5-alpha reductase inhibitor and an alpha-1 adrenergic receptor blocker

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2 years

Comparing insulin types

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8 months

Gram negative bacteria: 1. Diplococci 2. Curve rods 3. Bacilli 4. Coccobacilli

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2 years

Systematic approach to acid-base disorders: 1. Look at arterial pH (7.35-7.45) 2. Look at PaCO2 (NL ~36-44 mm Hg) 3. Look at HCO3- (NL ~20-28 mEq/L) 4. Check anion gap (NL=12): Na+ - (Cl- + HCO3-) Metabolic acidosis? MUDPILES vs HARDASS

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2 years

Zollinger-Ellison syndrome: pancreas non–beta islet cell, gastrin-secreting tumor that stimulates acid-secreting cells of stomach --> gastric mucosa hypertrophy, increased parietal cells, increased acid output --> GI mucousal ulceration diarrhea, malabsorption

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1 year

Cranial Nerves: Sensory, Motor or Both. --> "Some Say Marry Money, But My Brother Says Big Brain Matter Most" (S=Sensory, M=Motor, B=Both)

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2 years

Normal AP X-ray anatomy of the shoulder. Can you find the medial border of the scapula? 🩻

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1 year

Tuberculosis (TB) purified protein derivative (PPD) screen test measures induration, NOT erythema. >5 mm: HIV, immunosuppressed, or recent active TB contact >10 mm: IVDU, from place w/ high TB (< 5 y prior), health care worker, resident in high-risk setting >15 mm: all others

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2 years

Causes of acute and chronic cough, suggested diagnostics by @CritCultivation

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2 years

Hypertrophic cardiomyopathy (HCM) murmur --> high-pitched, crescendo-decrescendo, midsystolic murmur heard best at LLSB & does not radiate to carotids; Worsened by Valsalva, sudden standing, tachycardia (exercise, anxiety, etc); Athlete sudden death risk

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8 months

Rheumatoid arthritis - autoimmune polyarthritis; s/s: AM stiffness, joint swelling, fatigue symmetric effusions/swelling MCP and PIPJs, pannus, +RF, +anti-citrullinated protein antibody, ↑ESR, ↑CRP, leukocytosis, anemia, thrombocytosis; Rx: DMARD, NSAIDs, steroids, biologics

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2 years

Oxygen-hemoglobin dissociation curve plots hemoglobin saturation (%) vs. pO2 in mmHg Right shift (from NL) --> Hgb has a decreased affinity for oxygen & oxygen actively unloads. Left shift --> increased Hgb affinity for oxygen & increased reluctance to release O2

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11 months

Acute compartment syndrome - tissue psi w/in closed muscle compartment exceeds perfusion psi --> ischemia; MC location: calf; MCC: fractures, burn injuries, crush injuries, or soft tissue infection; 5 P’s = pain, pallor, paresthesia, pulselessness, paralysis; Rx: fasciotomy

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2 years

Conjunctivitis )bacterial v. Viral) and can be a STD

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2 years

Cardiac tamponade: fluid accumulation in pericardial sac, MCC trauma, malignancy, uremia, infection; Beck’s Triad – hypotension, muffled heart sounds, jugular vein distention plus pulsus paradoxus (systolic decrease on inspiration). Dx: echocardiogram; Rx: pericardiocentesis

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1 year

The #reflexes 🦵🏼🔨

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2 years

Allen's: Test for patency of ulnar artery primarily prior to placing a radial arterial line or performing ABG's - Occlude both arteries --> patient opens/closes fist --> release ulnar a. occlusion and assess color return; 30% of population has complete radial artery dominance.

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7 months

"5H5Ts" Reversible Causes of VT/VF

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10 months

Cellulitis plus sepsis (hypotension, instability) - MCC: Group A beta hemolytic Streptococcus pyogenes; Rx: IV antibiotics & fluids [broad-spectrum like cefepime plus coverage for MRSA (vancomycin)]; More mild case (MCC: Staph A.): Bactrim, clindamycin, Keflex

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1 year

Diarrhea? Is it noninflammatory (secretory, mild, watery) or inflammatory (invasive, toxin-laden, severe, bloody)?

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4 months

Syncope - transient loss of consciousness caused by transient global cerebral hypoperfusion with rapid onset, short duration and spontaneous complete recovery; MCC of syncope (mnemonic) —> HEAD HEART VESSELS

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9 months

Charcot's triad - 3 signs of acute cholangitis (bile duct bacterial infection) --> Fever, Jaundice, RUQ Abd Pain; Rx cholangitis: admit, IV antibx, bile duct obstruction relief (ERCP) or surgical; Reynolds' pentad = Charcot's triad PLUS altered mental status & shock (hypotension)

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10 months

In spine injury/disease, consider 3 main tracts in spine: 1. Anterolateral SpinoThalamic Tract - contralateral pain & temperature sensation to thalamus 2. CorticoSpinal Tract - ipsilateral motor from cortex 3. Dorsal Column - ipsilateral vibration and proprioception

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2 years

Cardiac physical examination in acute myocardial infarction (MI)

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2 years

T2DM medications may or may not encourage hypoglycemia. Know the mechanisms of action?

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1 year

Vision common defects - *Glaucoma - Peripheral loss *Cataracts - Blurred vision *Macular degeneration - Central loss (Age-related macular degeneration, AMD, is MCC of severe vision loss in adults over 60 in USA)

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8 months

Sensitivity (true positive rate) = measure of how well diagnostic test can correctly identify individuals who have condition or disease being tested for. Specificity = measure of how well diagnostic test can correctly exclude individuals who do not have the condition or disease

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2 years

Syphilis: STD spirochete Treponema pallidum: -Primary syphilis (local): painless chancre 3-6 wks -Secondary (disseminated): erythematous maculopapular rash palms & soles -Tertiary (systemic): 30%, wide involvement --> Lg. vessel chgs, CNS (neurosyphilis), benign mucosal gummas

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2 years

Ankle sprain : 3 types & 3 degrees

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1 year

G6PD deficiency episodes --> dark urine, jaundice, anemia, high reticulocyte count, low haptoglobin, high indirect bilirubin, high LDH, Heinz bodies (clumps of irreversibly denatured Hgb); Rx: avoiding precipitants and prn transfusions

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2 years

(Na+ + K+) – (Cl- + HCO3-) = Anion Gap; But there are "non-measured" contributors to AG, like albumin. Every 1 g/L decrease in albumin will decrease AG by 0.25 mmol/L. Patient w/ hypoalbuminemia may present with NL calculated AG when they actually have high anion gap acidosis.

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9 months

Pelvic inflammatory dz - Acute infection female genital tract (uterus, tubes, ovaries); High risk: mult sex partners; MCC: Chlamydia, gonorrhea; s/s: abd pain, uterine bleeding, vag d/c; Rx: ceftriaxone (500 mg-1 g) x1, doxycycline (100 mg BID 2w), metronidazole (500 mg BID 2w)

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2 years

Syndrome of Inappropriate Antidiuretic Hormone (SIADH): A major cause of euvolemic hyponatremia. Free H2O intake restroctopm is 1st-line Rx for SIADH euvolemic hyponatremia. H2O intake restriction = 0.5-1 liter/day. Gradual increased serum sodium/Na+ occurs over days w/ this Rx.

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2 years

Myasthenia gravis: type II hypersensitivity w/ antibodies targetting nicotinic acetylcholine receptors in muscle; s/s: ptosis, diplopia, muscle weakness that worsens with use; Dx: AChR, MuSK and LRP4 antibodies, RNS and SFEMG testing

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1 year

Sepsis - life threatening organ dysfunction, inappropriate host response to infection; Systemic inflammatory response syndrome (SIRS) criteria (2 or more): Temp >100.4F or <96.8F, HR >90/m, RR >20/m or PaCO2 <32 mmHg, WBC >12K or <4K; Rx: fluid resus, antimicrobial, vasopressors

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2 years

IgA nephropathy /Berger disease: glomerulonephritis w/ episodic hematuria and deposition of IgA in mesangium. IgA nephropathy is MC form of glomerulonephritis in adults

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2 years

SALTER I-V fracture pattern classification around the physeal growth plates of growing bones S - Straight Across, A - Above, L - Lower or beLow, T - Two or Through, ER - ERasure of growth place or cRush

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2 years

Mallory-Weiss Syndrome: mucosal tear at or below gastroesophageal junction; MCC of upper GI bleed; Cause: forceful vomiting, iatrogenic, trauma, hiatal hernia or corrosive ingestion; Dx: upper endoscopy; Rx: surgery or embolization

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1 year

Prinzmetal (vasospastic) angina - coronary artery spasms = chest pain at rest (w/ EKG chgs in ST segment); Cause: cold weather, exercise, substances (cocaine, pseudoephed); s/s: chest pain at rest ~ 5-15 min, early AM; W/up: EKG, troponin, stress test, coronary arteriography

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1 year

Hyperkalemia - iatrogenic (ACEI/ARBs), cell destruction (hemolysis, tumor lysis, burns), renal failure, adrenal insufficiency; s/s: Wkness, N/V, ↓DTRs; EKG: Peaked T waves, wide QRS, ↑PR int; Rx: Ca+ gluconate, beta-agonists, NaHCO₃, insulin, diuretics, kayexalate, dialysis

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2 years

Cluster headache pathology: vascular dilation, trigeminal nerve stimulation, and circadian effects. Histamine release, an increase in mast cells, genetic factors, and ANS activation also contribute

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2 years

Omphalocele - premature newborn (polyhydramnios in utero) w/ ascites & membrane-covered anterior abdominal mass (bowel loops visible) Def: Herniation of abdominal viscera thru abdominal wall into base of umbilical cord, covered by amniotic membrane and thin peritoneum but no skin

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2 years

Causes of angina pectoris / Stable vs. Unstable angina

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2 years

Indirect inguinal hernia: thru inguinal ring, thru external fascia, into scrotum; lateral to inferior epigastric vessels Direct inguinal hernia: protrudes through inguinal triangle (Hesselbach), through external superficial inguinal ring only; medial to inferior epigastric

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2 years

Wolff-Parkinson-White (WPW): tachycardia due to abnormal accessory cardiac electrical pathway, skipped heart beats, dizziness, lightheadedness, fainting; EKG: short PR interval, delta wave (conduction/preexcitation to ventricles through accessory pathway)

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2 years

Hyperkalemia causes = -excess intake of K+, -decreased excretion of K+, or -K+ shift from intracellular to extracellular space Decreased renal excretion (kidney failure, etc) especially w/ excess K+ intake, is MCC of hyperkalemia

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11 months

Pregnancy is assoc. w/ insulin resistance (placenta’s secretion: human placental lactogen); Screening for gestational diabetes ~24-28 wks gestation --> 1 hr 50-gr oral glucose tolerance test - If + >135 --> 3 hr 100 mg OGTT; fasting > 95 mg/dL, 1-hr >180, 2-hr >155, 3-hr >140

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2 years

Reactive Arthritis (hx: Reiter's): sexual (post chalamydia) or dysenteric (post Shigella, Salmonella, Yersinia, Campylobacter), pos HLA-B27 in 65-96%, arthritis, fever, fatigue, wt loss, enthesopathy, mucosa/tongue lesions, balanitis, hand/foot keratosis, conjunctivitis, aortitis

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2 years

Croup: parainfluenza virus infection upper airway, 6 mos - 3 y/o, Fall & early Winter mos, barking cough, stridor, xray: subglottic narrowing (steeple sign); Rx: humidified air or O2, antipyretics, PO/IV fluids, nebulized epinephrine, glucocorticoid (dexamethasone) singles dose

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2 years

Cutaneous nerves of the lower extremities

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2 years

Pinguecula: hyaline (fat, protein), elastic, yellow, elevated nodules of cornea Pterygium: fleshy, triangular growth of a pinguecula of cornea; Risk: windy, sandy, dusty, sunny environment

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2 years

Multiple Myeloma: neoplastic proliferation of plasma cells in bone marrow; Multiple skeletal lesions, hypercalcemia, renal insufficiency, and anemia; Patients typically present at ages > 40 with localized bone pain or a pathologic fracture

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2 years

Thrombocytopenia is a recognized complication after infection with Epstein-Barr virus, varicella virus, cytomegalovirus, rubella virus, or hepatitis virus (A, B, or C). But MC association is with vaguely defined viral upper respiratory infection or gastroenteritis

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2 years

APGAR at 1 & 5 minutes Appearance (color) Pulse (heart rate) ♥️ Grimace 😬 Activity (tone) 💪 Respirations 🫁

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10 months

Aortic dissection - tear of inner layer of aorta; Risk: hypertension & acute, severe increases of BP (wt lifting, energy drinks, cocaine); s/s: tearing & ripping chest pain w/ pulse deficits; Rx: lower BP via IV beta-blockers for both Type A and B and then surgery (for Type A)

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2 years

Neuropathic (Charcot) arthropathy: Peripheral neuropathy --> fractures, dislocations, subluxations --> progressive bony destruction, resorption --> deformity; Foot & ankle (MC), shoulder, elbows; Causes: DM, syphillis, syringomyelia, trauma, leprosy, spine tumor, VitB12 def

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29 days

Sensitivity - True positives Specificity - True negatives

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2 years

Virchow's triad = 3 factors that may predispose a person to the development of venous thrombosis: •Hypercoagulability •Stasis •Endothelial injury

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2 years

Lithium requires regular monitoring of TSH, Ca+/PTH, and BMP. Lithium has adverse effects on the kidneys, thyroid gland and parathyroid glands

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2 years

69 y/o alcoholic male, lethargic, tremors, liver cirrhosis, icterus, ascites, LE edema, asterixis --> Decompensated cirrhosis (hepatic encephalopathy from hyperammonemia, AMS, asterixis); Rx: lactulose (clears ammonia via induced voluminous diarrhea)

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2 years

Endometriosis: benign endometrial tissue outside of uterus (ovaries, pouch of Douglas MC sites), infertility (adhesions, scarring), 3Ds (dyspareunia, dyschezia , dysmenorrhea), Dx: laparoscopy w/ bx. Rx: OCP, GnRH antagonists (↓estrogen), Danazol (↓FSH/LH surge), NSAID, Surgery

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3 months

Approaching Jaundice ( @ManualOMedicine )

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7 months

Tetralogy of Fallot 4 abnormalities: 1. Pulmonary Stenosis (usually subpulmonic) 2. Ventricular Septal Defect w/mixing of oxygenated & deoxygenated blood 3. Overriding Aorta, over both ventricles w/ blood from L & R ventricles 4. Right Ventricular Hypertrophy (increased workload)

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2 years

Cystic Fibrosis: AR mutation of transmembrane chloride channel CFTR , thickened secretions, recurrent resp infection, pancreatic insufficiency, sinonasal dz (recurrent sinusitis) and failure to thrive in kids, nasal polyposis. Dx: Sweat chloride ≥60 mEq/L (2 occasions)

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2 years

Five classes of T2 DM diabetes medications. Know the mechanism of action and side effects of each med in each class

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2 years

RUQ pain (recurrent), fever, jaundice (Charcot triad) + dilatation of common bile duct (obstruction/stasis), bile duct wall thickening, biliary bacterial infection --> Cholangitis Ascending cholangitis: Charcot triad + septic shock & altered mental status (Reynold pentad)

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1 year

Acute Compartment Syndrome P's --> pain, pallor, paresthesia, pulselessness, paralysis due to limb threatening increased pressure within a confined closed fascial space, resulting in reduced blood flow; Monitor intracompartmental tissue pressure

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2 years

Bilirubin 2 forms; unconjugated and conjugated. Unconjugated bilirubin is NOT soluable in water. Travels in blood if bound to albumin; Not directly excreted. (prehepatic & hepatic jaundice) Conjugated bilirubin is water soluble & can be excreted. (posthepatic jaundice)

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4 months

Causes of Pancreatitis - "l Get Smashed"

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1 year

Hemochromatosis: autosomal recessive (HFE mutation) excessive iron deposition in liver, pancreas & heart; s/s: hyperpigmentation, weakness, hepatomegaly, elevated LFTs, diabetes mellitus; Labs: high serum iron, high ferritin, high transferrin sat %, low transferrin. Rx:phlebotomy

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2 years

Reye syndrome: acute encephalopathy + fatty liver infiltration, often after acute viral infection (influenza A or B or varicella), particularly when salicylates (ASA) are used; Children < 18 yrs, late fall and winter MC

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10 months

• Left ventricular enlargement • Double atrial shadow • Elevated left main bronchus • Wide carina angle • Prominent bilateral upper lung vascularity Mitral Regurgitation with Pulmonary HTN

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2 years

Pectus excavatum

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2 years

Acute respiratory distress syndrome (ARDS) = ⇑ permeability alveolar-capillary membranes ⇒ protein-rich pulmonary edema (non-cardiogenic) w/in 12-24 hrs 75% of cases: - Sepsis syndrome (MCC) - Severe multiple trauma - Aspiration (alcoholics), toxic inhalation, near-drowning

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1 year

Hydrochlorothiazides - thiazide diuretics inhibit Na/Cl symporter in renal distal convoluted tubules; Can cause hypokalemia, hyponatremia, hyperuricemia, & hypercalcemia, hyperglycemia (↓insulin sensitivity & ↓glucose tolerance --> ↑blood glucose)

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2 years

What are some of the things that can happen with psoriatic nails?

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2 years

Methanol intoxication: difficult to arouse, abdominal pain, vision changes, metabolic acidosis (increased anion gap) "MUDPILES CAT" = Increased anion gap metabolic acidosis causes

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8 months

Amygdala - almond-shaped brain structure; Roles: Emotional control, positive emotions triggered by rewarding stimuli, interprets ext stimuli & alerts hippocampus, flight-or-fight, attaches emotional significance to memories, emotional responses & learning, helps control fear

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2 years

Tinea versicolor: Malassezia furfur yeast, spaghetti & meatballs on histo & KOH, hypopigmented from melanocyte inhibition & organism “bleaching, hypopigmented scaly macules/patches; Rx: selenium sulfide shampoo, -azoles

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2 years

Diff Dx of malignant tumors of the small bowel 1. Adenocarcinoma (50%) 2. Carcinoid (25%) 3. Lymphoma (20%) 4. Sarcoma/gastrointestinal stromal tumor (GIST) (~5%)

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2 years

Hordeolum (stye) = acute, warm, tender abscess of eyelid w/ pain, swelling; MCC: Staphylococcus aureus. Risk: dirty eye makeup, rosacea, seborrheic dermatitis. Rx: warm compresses (10 min, 5 x daily), massaging eyelid to aid drainage

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2 years

Characteristics of Pain: Neuropathic, Somatic and Visceral Neuropathic pain typical descriptors are: pulsing, throbbing, shooting, stabbing, burning, tingling. Somatic pain --> sharp, aching, sore, tender. Visceral pain --> cramping, pressing, crushing, wrenching.

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