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Step 2 Mehlman
Mehlman
| Term | Definition |
|---|---|
| chicken + bloody diarrhea | campylobacter or salmonella |
| tx for entamoeba | metronidazole |
| bloody + “appendicitis” | yersinia |
| test for guillian barre | electromyography and nerve conduction |
| CF patient under 10 type of pneumonia | Staph Staph until 10, then pseudo |
| CP patient over 10 type of pneumo | pseudomonas |
| type of incontinence for mid-urethral sling | stress incontinence |
| 2 tx can use for pyelonephritis | cipro or amp/gent |
| what do you need to check in RA patient before surgery | atlanto instability do CT |
| empric for endocarditis | Vanc. or amp/sulbactum and gent |
| anti-cholinergic to stop pee | oxybutinin |
| cholinergic to help pee | bethanachol |
| tx for MS flares vs maintanence | steroids for flares, interferon for mainanence |
| vestibular neuritis vs labyrinthitis | Labyrinthitis has tinnitus and hearing loss |
| to and fro murmur | PDA |
| murmur associated with rubella | PDA |
| heart problem of baby born to mom who has lupus | third degree heart block |
| heart problem in williams | Supravalvular AS |
| worse with valsalva | HOCM |
| late peaking sys murmur with ejection click | AS |
| Travel + self-limiting watery or brown/green diarrhea | Traveler diarrhea = ETEC HL or HS toxin |
| Abx (clindamycin, beta-lactam, cephalosporin) + diarrhea | C. difficile |
| Dx of C. diff | stool AB toxin test, not stool culture |
| Fever of 104 + abdo distension in C diff | toxic megacolon |
| Tx of C. diff | vancomycin, not metronidazole (updated guidelines as of Feb 2018) |
| Bloody diarrhea + travel | Entamoeba histolytica |
| Tx of E. histolytica | metronidazole + iodoquinol; can give paromomycin |
| Close quarters or military barracks or cruise ship + watery diarrhea | Norwalk virus |
| Child <5 years + watery diarrhea | rotavirus |
| Few organisms causing bloody diarrhea | Shigella |
| Bloody diarrhea + appendicitis-like pain (pseudoappendicitis) in a child | Yersinia enterocolitica |
| Bloody diarrhea + reactive arthritis in an adult | Y. enterocolitica, Campylobacter, Shigella, Salmonella |
| Diarrhea + Guillain-Barre syndrome | Campylobacter |
| GBSyndrome CSF? | albuminocytologic dissociation (high protein + normal cells) |
| GBSyndrome Dx? | electromyography + nerve conduction studies (on NBME) |
| Cardiac ischemia + need to evaluate | ECG stress test first-line |
| Cardiac ischemia + abnormal baseline ECG (e.g., BBB) | Echo stress test (need normal ECG to do ECG stress test) |
| Cardiac ischemia + patient can’t exercise | dobutamine + ECG/echo |
| ECG shows diffuse ST-segment elevations | pericarditis |
| Pericarditis Tx | NSAID, or steroid, or colchicine |
| Central chest pain worse when supine; better when leaning forward | pericarditis |
| Lateral chest pain after viral infection + increased CK | pleurodynia (intercostal muscle spasm) |
| ST-segment depressions in the anterior ECG leads | posterior MI |
| Electrical alternans on ECG | pericardial tamponade / pericardial effusion |
| Pulsus paradoxus (drop in systolic BP >10 mm with inspiration) | cardiac tamponade or severe asthma |
| Beck triad | hypotension + muffled heart sounds + JVD |
| Bloody diarrhea + poultry consumption | Campylobacter jejuni or Salmonella spp. |
| Tx of tamponade | pericardiocentesis or pericardial window |
| Tamponade | do echo before pericardiocentesis if both listed (even though sounds wrong, on 2CK NBME) |
| CPP + lobar pattern (right-lower lobe consolidation + dullness to percussion) | Strep pneumo |
| CPP + lobar pattern, but they say “interstitial” in the vignette description | Mycoplasma, not S. pneumo Empiric Tx for CPP |
| Tx for CPP is pt on Abx past three months | fluoroquinolone over azithro |
| Pneumonia in CF patient <10 years | S. aureus exceeds Pseudomonas |
| Pneumonia in CF patient >10 years | Pseudomonas exceeds S. aureus. |
| Pneumonia after influenza infection | USMLE wants S. aureus |
| Pneumonia + rabbits | F. tularensis |
| Pneumonia + cattle | Coxiella (Q fever) |
| Pneumonia + birds | Chlamydia psittaci |
| Leg swelling + pain + shortness of breath | Pulmonary embolism caused by DVT |
| Tx of PE | Heparin before spiral CT |
| Tx of PE in pregnant woman | V/Q scan, not CT |
| Tx of PE in someone already on warfarin | spiral CT to confirm, then IVC filter |
| Acid-base disturbance in PE | resp. alkalosis (low CO2, high pH, low O2, normal bicarb [too acute to change]) Acid-base disturbance in asthma |
| Acid-base disturbance in aspirin toxicity first 20 mins | resp. alkalosis (low CO2, high pH, normal O2, normal bicarb [too acute to change]) |
| Acid-base disturbance in aspirin toxicity after 20 mins | mixed metabolic acidosis-respiratory alkalosis (low CO2, low pH, normal O2, low bicarb) |
| Tx for aspirin toxicity | bicarb (increased excretion through urinary alkalinization) |
| Tx for TCA toxicity | sodium bicarb |
| Normal calcium | 8.4-10.2 mEq/L |
| Tx of hypercalcemia | 10.2-12 -> normal saline (0.9% NaCl) |
| MEHLMANMEDICAL.COM | |
| MEHLMANMEDICAL.COM 4 | |
| Community-acquired pneumonia (CPP) + bilateral CXR infiltrates | Mycoplasma |
| Tx of hypercalcemia | 12-14 -> normal saline (0.9% NaCl) only if asymptomatic; add bisphosphonate (e.g., pamidronate) if symptomatic |
| Tx of hypercalcemia | 14+ -> normal saline (0.9% NaCl) + bisphosphonate |
| High calcium + polyuria | nephrogenic diabetes insipidus (weird, but on NBME) |
| High calcium + confusion | delirium caused by high calcium |
| Low calcium or potassium not responsive to supplementation | cause is low Mg |
| Low calcium or potassium in alcoholic | hypomagnesemia is cause |
| Ataxia, confusion, ophthalmoplegia | Wernicke encephalopathy (B1 deficiency) |
| Retrograde amnesia + confabulation in alcoholic | Korsakoff psychosis |
| Wernicke-Korsakoff syndrome | mammillary bodies |
| Hx of many pregnancies + downward movement of vesicourethral junction | stress incontinence |
| Tx of stress incontinence | pelvic floor exercises (Kegel); if insufficient |
| Hyperactive detrusor or detrusor instability | urge incontinence |
| Need to run to bathroom when sticking key in a door | urge incontinence |
| Incontinence in multiple sclerosis patient or perimenopausal | urge incontinence |
| Tx of urge incontinence | oxybutynin (muscarinic cholinergic antagonist) or mirabegron (beta-3 agonist) Incontinence + high post-void volume (usually 3-400 in question; normal is <50 mL) |
| Tx for overflow incontinence in diabetes | bethanacol (muscarinic cholinergic agonist) |
| Incontinence in BPH | overflow incontinence due to outlet obstruction |
| Tx for overflow incontinence in BPH | insert catheter first; then give alpha-1 blocker of 5-alpha-reductase inhibitor; then TURP if necessary |
| Exquisitely tender prostate on digital rectal exam | prostatitis |
| Prostatitis Tx | ciprofloxacin (fluoroquinolone |
| Costovertebral angle tenderness + fever | pyelonephritis |
| Costovertebral angle tenderness + granular casts | pyelonephritis (correct, super-weird; NOT acute tubular necrosis; this is on 2CK NBME) |
| Tx for pyelonephritis | ciprofloxacin, OR ampicillin + gentamicin |
| Saddle anesthesia + urinary retention | cauda equina syndrome |
| MEHLMANMEDICAL.COM | |
| MEHLMANMEDICAL.COM 5 | |
| Perianal anesthesia + urinary retention or incontinence | conus medullaris syndrome |
| Gradual-onset dementia + no sensory or motor dysfunction | Alzheimer |
| Mini-mental state exam score low + patient tries to do well | Alzheimer |
| Mini-mental state exam score low + patient is apathetic / takes long to perform tasks / does poorly on reverse serial 7s | depression (pseudodementia) |
| Patient complains about memory loss | normal aging, not Alzheimer |
| First-line Tx for Alzheimer | donepezil (cholinesterase inhibitor also give galantamine or rivastigmine |
| NMDA receptor (glutamate receptor) antagonist used in Alzheimer Tx | memantine |
| Step-wise dementia/decline and/or sensory/motor disturbance | vascular dementia |
| Hx of hypertension + dementia + sensory/motor disturbance | vascular dementia |
| Visual hallucinations + Parkinsonism + dementia | Lewy body dementia |
| Apathy + disinhibition + personality change + dementia | frontotemporal dementia (Pick disease) |
| Urinary incontinence + ataxia + CNS dysfunction (wet, wobbly, wacky) | Normal-pressure hydrocephalus |
| Wet, wobbly, wacky + Parkinsonism | still NPH |
| Parkinsonism in young patient | Wilson disease till proven otherwise |
| Parkinsonism in older patient | Parkinson disease |
| Parkinsonism + axial dystonia | progressive supranuclear palsy |
| Tx of UTI | TMP/SMX or nitrofurantoin |
| Tx of cystitis | nitrofurantoin (need not be pregnant) |
| Waiter tip position in kid | upper brachial plexus injury |
| Claw hand | lower brachial plexus |
| Pronated arm + wrist-drop | radial nerve injury |
| Midshaft fracture of humerus | Radial nerve injury |
| Supracondylar fracture of humerus | median nerve injury |
| Surgical neck of humerus fracture | axillary nerve injury |
| Medial epicondylar injury | ulnar nerve injury |
| Weakened biceps + loss of sensation of lateral forearm | musculocutaneous nerve injury |
| Paresthesias + pain following burn or casting | compartment syndrome |
| MEHLMANMEDICAL.COM | |
| Compartment syndrome Dx | measure compartment pressure |
| Compartment syndrome Tx | fasciotomy of uncast |
| Guy lifts heavy box | severe lower back pain + muscle spasm + no radiculopathy |
| Lumbosacral strain diagnosis | DO NOT x-ray |
| Lumbosacral strain Tx | NSAIDs + exercise as tolerated; bedrest is the WRONG answer |
| Guy lifts heavy box | severe lower back pain + radiculopathy |
| Point tenderness over a vertebra in older woman | osteoporosis (compression fracture) |
| Point tenderness over a vertebra in younger patient on steroids | osteoporosis (compression fracture) |
| Point tenderness over a vertebra in patient with autoimmune disease | recognize patient is on steroids -> osteoporosis (compression fracture) |
| Point tenderness over a vertebra in IV drug user | epidural abscess |
| “Step-off” of one vertebra relative to another | spondylolisthesis |
| Back pain worse in the morning and gets better throughout day in male 20s-40s | ankylosing spondylitis |
| Bamboo spine | ankylosing spondylitis |
| Dx of AS | x-ray of sacroiliac joints |
| Back pain worse when standing or walking for long periods of time | lumbar spinal stenosis |
| Radiculopathy down an arm | cervical disc herniation |
| Bilateral paresthesias in the arms in rheumatoid arthritis patient | atlantoaxial subluxation |
| Bilateral paresthesias in the arms in rheumatoid arthritis patient | MR of spine to Dx atlantoaxial subluxation |
| Prior to surgery in rheumatoid arthritis patient | cervical CT or flexion/extension x-rays of cervical spine to check for atlantoaxial subluxation |
| Back pain in elderly patient with hypercalcemia | multiple myeloma or metastases |
| Back in pain in patient with history of other type of cancer | metastases |
| Suspected spinal mets | MRI |
| Metastases to long bones in prostate cancer | osteoblastic (Dx with bone scan); spine do MRI |
| High hemoglobin +/- pruritis after shower +/- plethora +/- splenomegaly | polycythemia vera |
| High hemoglobin + low EPO | polycythemia vera |
| Pruritis after shower | basophilia |
| High hemoglobin + lung disease / low pO2 | secondary polycythemia (high EPO) |
| MEHLMANMEDICAL.COM | |
| Polycythemia + hypercalcemia + smoker + red urine | RCC (paraneoplasic EPO + PTH-rp) |
| Blurry vision or Raynaud or pain in fingers or headache | hyperviscosity syndrome Hyperviscosity syndrome |
| Hereditary spherocytosis | AD, ankyrin or spectrin or band protein deficiency; Tx = splenectomy Treatment for ITP |
| Tx for hereditary hemochromatosis | serial phlebotomy |
| Tx for secondary hemochromatosis (transfusional siderosis) | chelation therapy (deferoxamine) |
| Viral infection + tinnitus + vertigo +/- neurosensory hearing loss | labrynthitis |
| Viral infection + vertigo | vestibular neuritis |
| Tx for multiple sclerosis flares | IV steroids (IV methylprednisolone) |
| Given to MS patients between flares | interferon-beta |
| Tx for spasticity in MS | baclofen (GABA-B receptor agonist) |
| Incontinence in MS | urge (hyperactive detrusor, as mentioned earlier) |
| New-onset murmur + fever | endocarditis till proven otherwise |
| Empiric Tx for endocarditis | vancomycin or ampicillin/sulbactam, PLUS gentamicin |
| Beta-lactam (e.g., nafcillin) or cephalosporin + rash + renal issue | interstitial nephritis |
| Interstitial nephritis | WBCs in the urine (eosinophils) |
| Fixed splitting of S2 | atrial septal defect |
| Holosystolic murmur at left sternal border PLUS either parasternal heave or palpable thrill | VSD |
| Holosystolic murmur at left sternal border PLUS diastolic rumble | also VSD |
| To-and-fro murmur | PDA (on 2CK NBME) |
| Pan-systolic-pan-diastolic murmur | PDA |
| Continuous, machinery-like murmur | PDA |
| Congenital rubella syndrome | PDA |
| Heart problem in neonate of mom with SLE | congenital third-degree heartblock |
| Heart problem in William syndrome | supravalvular aortic stenosis |
| Bicuspid aortic valve | aortic stenosis |
| Mid-systolic (crescendo-decrescendo) murmur + gets worse with Valsalva | HOCM |
| Mid-systolic (crescendo-decrescendo) murmur + no change or softens with Valsalva | aortic stenosis MEHLMANMEDICAL.COM 8 |
| MEHLMANMEDICAL.COM | |
| Myxomatous degeneration of mitral valve | mitral valve prolapse |
| Marfan or Ehlers-Danlos syndrome | MVP or aortic regurg |
| Rheumatic heart disease acutely (onset of Group A Strep infection) | mitral regurg |
| Rheumatic heart disease later on (years after infection) | mitral stenosis |
| Mid-systolic click | MVP |
| Late-peaking systolic murmur with ejection click | another way they describe aortic stenosis |
| Bounding pulses + massively wide pulse pressure | aortic regurg |
| Brisk upstroke + precipitous downstroke of pulse | aortic regurg |
| Syncope + angina + dyspnea (SAD) | aortic stenosis |
| Dyspnea in second trimester of pregnancy | mitral stenosis |
| Dyspnea late in pregnancy | peripartum cardiomyopathy |
| Screening at age 50 | mammogram (every two years) + colonoscopy (every ten years) |
| Colon cancer in first-degree relative (sibling or parent) | start at age 40 or ten years before diagnosis in relative, whichever is earlier, and do every 5 years. |
| Breast imaging (if performed) | ultrasound only under age 30; over age 30 do mammogram +/- ultrasound |
| Anuria (no urine output) after removal of catheter | acute urethral obstruction |
| Contrast induced nephropathy; how to prevent | saline hydration beforehand |
| BUN/Cr > 20 | prerenal (hypovolemia) |
| BUN/Cr <20 | not prerenal (15-20 for post-renal, and <15 for intra-renal is wrong on 2CK NBMEs) |
| Blood loss + oliguria | acute tubular necrosis |
| Blood loss + obstetric catastrophe | diffuse cortical necrosis |
| Sickle cell + nephrotic syndrome | focal segmental glomerulosclerosus |
| Sickle cell + red urine | renal papillary necrosis |
| 2+ blood in urine but 0-4 RBCs/HPF on LM | false + blood on dipstick |
| Pleural / supradiaphragmatic plaques | asbestosis |
| Preferred antibiotic in sepsis | ceftriaxone |
| Sepsis Tx in young children | cefotaxime |
| Tx for spontaneous bacterial peritonitis | ceftriaxone |
| Cirrhosis or recent peritoneal dialysis or nephrotic syndrome + fever + abdo pain | SBP |
| Dysphagia to solids and liquids at the same time to start | says neurogenic cause |
| Dysphagia to solids that progresses to solids and liquids | esophageal cancer |
| Halitosis +/- gurgling sound when swallowing +/- regurgitation of undigested food | Zenker |
| Zenker + achalasia initial Dx modality | barium swallow |
| After barium swallow is done and shows bird’s beak appearance | monometry to confirm Dx of achalasia |
| Pt with Hx of GERD + dysphagia | straight to endoscopy to rule out cancer |
| Diabetic pt with new-onset GERD | diabetic gastroparesis |
| Diabetic pt with new-onset GERD | give metoclopramide, not PPI |
| Diabetic gastroparesis before giving med | endoscopy first to rule out physical obstruction |
| Endoscopy negative for diabetic gastroparesis | do gastric-emptying scintigraphy |
| Bulimia nervosa or anorexia | never give buproprion (seizure risk) |
| Electrolyte abnormality in anorexia | hypokalemia |
| Most common cause of death in anorexia | arrhythmia from hypokalemia |
| Refeeding syndrome | worry about hypophosphatemia |
| Tx of anorexia + depression | mirtazapine (alpha-2 antagonist); stimulates appetite |
| Amenorrhea in anorexia | low FSH + low estrogen (hypogonadotropic) |
| Premature ovarian failure + Turner syndrome + menopause | high FSH (low inhibin) + low estrogen |
| Cholelithiasis | Dx with abdo ultrasound; fat, forties, female, fertile |
| Biliary colic + fever | cholecystitis |
| Tx of cholelithiasis + cholecytitis | cholecystectomy |
| Pt doesn’t want surgery or is pregnant | ursodeoxycholic acid (ursodiol) |
| Abdo USS negative in suspected cholecystitis | HIDA scan |
| Gall bladder doesn’t light up on HIDA scan | confirms cholecystitis |
| Cholelithiasis in pregnancy | estrogen upregulates HMG-CoA reductase + progesterone slows biliary peristalsis |
| Trichotillomania (eating one’s hair) + GI symptoms | gastric bezoar (hair ball) |
| Hx of surgery + high-pitched bowel sounds or acute-onset abdo symptoms | small bowel obstruction (SBO) |
| MEHLMANMEDICAL.COM | |
| Renal failure + friction rub over chest | uremic pericarditis |
| High leukocytes + low leukocyte ALP | CML |
| Metamyelocytes + myelocytes + splenomegaly | CML |
| Tx of CML | imatinib; causes fluid retention / edema |
| Smudge cells + autoimmune hemolytic anemia | CLL |
| Auer rods | AML; composed of myeloperoxidase |
| Tx of AML | DIC caused by Auer rod release into blood |
| Kid with high lymphocytes | ALL or pertussis (weird bc bacterial, but lymphocytes often >30k) Dry cough in winter |
| Young African American woman + dry cough + normal CXR | asthma (activation of mast cells), not sarcoidosis Young African American woman + dry cough + nodularity on CXR |
| Hypercalcemia in sarcoid, why? | epithelioid (activated) macrophages produce 1-alpha hydroxylase, thereby activating vitamin D3 |
| Increased calcium in sarcoid | means decreased calcium in feces (bc D3 increased small bowel absorption) Tx for sarcoid |
| Outpatient Tx of asthma | SABA, then low-dose ICS, then maximize dose of ICS, then LABA, then use any number of drugs (e.g., mast cell stabilizers, anti-leukotriene, etc.), then oral steroids last resort |
| Kid with asthma on SABA inhaler + not effective + next best step? | ICS (fluticasone) |
| Kid with asthma on SABA inhaler + most effective way to decrease recurrence? | oral steroids (not next best step, but certainly most effective) |
| 40s male + hematuria + hemoptysis | Goodpasture syndrome |
| Antibodies in Goodpasture | Anti-GBM (anti-collagen IV) |
| Dx of Goodpasture | antibodies first, but confirmatory is renal biopsy showing linear immunofluorescence Hematuria + hemoptysis + “head-itis” (mastoiditis, sinusitis, otitis, nasal septal perforation) |
| New name for Wegener | granulomatosis with polyangiitis |
| Dx of Wegener | c-ANCA (anti-PR3; anti-proteinase 3) |
| Asthma + eosinophilia | Churg-Strauss |
| MEHLMANMEDICAL.COM | |
| MEHLMANMEDICAL.COM 11 | |
| New name for Churg strauss | eosinophilic granulomatosis with polyangiitis |
| Dx of CS | p-ANCA (anti-MPO; anti-myeloperoxidase) |
| Hematuria in isolation + p-ANCA in serum | microscopic polyangiitis (MP) |
| Severe renal disease in Wegener or Goodpasture or MP | rapidly progressive glomerulonephritis (crescentic) High ALP + high direct bilirubin + high amylase or lipase |
| High ALP + high direct bilirubin + high amylase or lipase + remote Hx of cholecystectomy | sphincter of Oddi dysfunction (can’t be a stone cuz the gallbladder was removed ages ago) |
| High ALP + high direct bilirubin + normal amylase or lipase in someone with recent cholecystectomy | choledocholithiasis (retained stone in cystic duct that descended, but not distal to pancreatic duct entry point) Dx and Tx of choledocholithiasis |
| High ALP + high direct bilirubin + normal amylase or lipase in someone with remote cholecystectomy | pancreatic cancer |
| Dx of pancreatic cancer | CT abdo with contrast |
| High ALP + high direct bilirubin + normal amylase or lipase in someone with remote cholecystectomy + CT is negative | cholangiocarcinoma |
| High ALP + high direct bilirubin + normal amylase or lipase + diffuse pruritis + high cholesterol | primary biliary cirrhosis (PBC) |
| High ALP + high direct bilirubin + normal amylase or lipase + autoimmune disease (in pt or family) | PBC Dx of PBC |
| Recent cholecystectomy + fever + abdo pain | post-op bile leak |
| High ALP + high direct bilirubin + normal amylase or lipase + CT shows cystic lesion in bile duct | choledochal cyst |
| Imaging to view liver or pancreas | CT with contrast |
| Imaging to view gallbladder | Ultrasound |
| Imaging to view gallbladder in suspected cholecystitis only if USS negative | HIDA scan |
| Imaging to view bile ducts | ERCP or MRCP (choose ERCP > MRCP if both listed) |
| Teenage girl with Hx of cutaneous candida infections since childhood | chronic mucocutaneous candidiasis MCC |
| Bacterial + fungal + protozoal + viral infections since birth | SCID |
| MEHLMANMEDICAL.COM | |
| MEHLMANMEDICAL.COM 12 | |
| Bacterial infections since age 6 months | Bruton |
| Bacterial infections only since birth | Bruton (rare as hell to say from birth, but it’s on new 2CK NBME) |
| SCID XR variant | common gamma-chain mutation (IL-2 receptor deficiency) |
| SCID AR variant | adenosine deaminase deficiency |
| Bruton mechanism | tyrosine kinase mutation |
| Hyper IgM syndrome | deficiency of CD40 ligand on T cell (can’t activate CD40 on B cell to induce isotype class switching) |
| Greasy, scaly scalp + itchy + papules + adult | seborrheic dermatitis |
| Tx for SD | azole or selenium shampoo |
| Tx for tinea capitis | oral griseofulvin for patient only |
| How to decrease risk of tinea capitis | avoidance of sharing of hats |
| Tx of onychomycosis (nailbed fungus) | oral terbinafine |
| Tx of tinea pedis | topical terbinafine or topical azole |
| Tx of tinea corporis (ring worm) | topical azole (clotrimazole or miconazole) |
| Tx of cutaneous candida | oral azole |
| Tx of oropharyngeal candida | nystatin mouthwash |
| Tx of esophageal candidiasis | oral azole, not nystatin mouthwash |
| Tx of vaginal candidiasis | topical nystatin before trying oral azole |
| Odynophagia (painful swallowing) in immunocompromised pt | esophageal candidiasis till proven otherwise |
| CNS fungal infection or fungemia (rigors/chills) | amphotericin B |
| Cryptococcal meningitis | amphotericin B + flucytosine, then do fluconazole taper |
| Simple fungal pneumonia | fluconazole |
| Sporothrix schenckii (rose thorn + finger papule) | itraconazole |
| Hypopigmentation on upper back / trunk | tinea versicolor (Malassezia furfur) |
| Tx of tinea versicolor | topical selenium |
| Most common cause of impetigo | S. aureus now exceeds S. pyogenes |
| Tx of impetigo | topical mupirocin |
| Beefy red, well-demarcated skin plaque | erysipelas |
| Most common cause of erysipelas | Group A Strep (S. pyogenes) >>> S. aureus |
| MEHLMANMEDICAL.COM | |
| More diffuse pink skin lesion + tenderness + fever | cellulitis |
| Most common cause of cellulitis | S. aureus exceeds S. pyogenes |
| Tx of erysipelas + cellulitis | oral dicloxacillin or oral cephalexin |
| Wide-complex tachyardia | ventricular tachycardia (VT) |
| Narrow-complex tachy | SVT |
| Tx for SVT | vagal/carotid massage first; if doesn’t work, then adenosine |
| Tx of VT | anti-arrhythmics, e.g., amiodarone |
| Tx of SVT or VT in setting of coma / unconsciousness | direct-current countershock |
| Tx of first-degree heartblock or second-degree Mobitz I (Wenckebach) | observe |
| Tx of second-degree Mobitz II or third-degree heartblock | pacemaker |
| First-degree heartblock | PR-interval >200 milliseconds |
| Mobitz I | gradually prolonging PR-interval before a QRS drops |
| Mobitz II | no gradual prolongation of PR-interval; QRS randomly drops |
| Third-degree | HR super slow at 30-40; no relation between p-waves and QRS complexes |
| Infective causes of third-degree | Lyme disease, congenital lupus, diphtheria |
| Give killed IM influenza vaccine when? | Every year in fall/winter only; start from 6 months of age |
| Killed IM Influenza vaccine safe in pregnancy? | Yes, give anytime to pregnant women |
| Live-attenuated intranasal influenza vaccine guidelines? | Only give age 2-49 to non-pregnant, non- immunocompromised persons |
| Vaccines at age 2, 4, 6 months: HepB, Polio Salk, Pneumo PCV13, DPT, HiB, rotavirus (also give HepB at birth) HPV vaccine when | age 9-45 |
| Mom’s HepB status unknown | give neonate HepB vaccine; only give immunoglobulin if mom comes back + MMR |
| Varicella | one dose between 12-18 months |
| Age 65 or older | give Pneumo PCV13 followed by PPSV23 6-12 months later |
| Asplenia or sickle cell | PCV13 + PPSV23 + HiB + Meningococcal |
| Circular lesion in pancreas seen in pancreatitis | pseudoabscess |
| Centri-acinar emphysema | smokers |
| Pan-acinar emphysema | alpha-1 anti-trypsin deficiency |
| Young adult + non-smoker + has emphysema + relative died of hepatic cirrhosis | alpha-1 anti-trypsin deficiency |
| CREST syndrome lung pathology? | can cause pulmonary fibrosis |
| Restrictive lung disease | normal or increased FEV1/FVC |
| Obstructive lung disease | decreased FEV1/FVC |
| Why is FEV1/FVC normal or high in restrictive? | radial traction on outside of airways is sticky (keeps airways from closing) |
| Apex to base lung changes when sitting/standing | both ventilation + perfusion increase apex to base |
| Most common cause of otitis media | Strep pneumo |
| Tx of otitis media | oral amoxicillin only |
| Tx of recurrent OM | amoxicillin/clavulanate |
| When to do tympanostomy tube | three or more OM in 6 months, or 4 or more in a year |
| Most common cause of otitis externa | Pseudomonas |
| Tx of otitis externa | topical ciprofloxacin + hydrocortisone drops |
| Prevention of OE in someone with constant water exposure (e.g., crew team) | alcohol-acetic acid drops |
| Tx of earwax buildup | carbamide peroxide drops |
| Low hematocrit chronic disease Low hematocrit anemia | |
| + low MCV + low transferrin + low TIBC + transferrin saturation normal or low | anemia of |
| + low MCV + high transferrin + high TIBC + transferrin saturation super-low | iron deficiency |
| + low MCV + increased red cell distribution width (RDW) | iron deficiency anemia + low MCV + low/low-normal RDW |
| + low MCV + low iron + low ferritin | iron deficiency |
| + low MCV + normal iron + normal or high ferritin | thalassemia |
| Low hematocrit | |
| Low hematocrit | |
| Low hematocrit | |
| Low hematocrit | |
| Low hematocrit | |
| thalassemia | |
| Microcytic anemia that doesn’t improve with iron supplementation | thalassemia Dx of thalassemia |
| + low MCV + normal iron + normal ferritin in pregnant woman on iron supplements | |
| Low hematocrit + normal MCV + low iron + normal or high ferritin | anemia of chronic disease |
| Tx of anemia of chronic disease if renal failure is cause | answer = EPO |
| Tx of anemia of chronic disease if renal failure not cause (IBD, RA, SLE, etc.) | CANNOT give EPO; Tx |
| underlying condition. | |
| High BP + smoker + TIA or stroke or retinal artery occlusion. How to best decrease stroke risk | Answer = |
| lisinopril, not smoking cessation | |
| Normotensive old pt + TIA or stroke or retinal artery occlusion | atrial fibrillation |
| Hypertensive pt + stroke | do carotid duplex ultrasound |
| Normotensive pt + stroke | do ECG; if ECG normal |
| High BMI female + irregular menstrual cycles | anovulation |
| Anovulation + hirsutism | PCOS |
| Anovulation. Cause USMLE wants? | insulin resistance |
| Why hirsutism in anovulation | abnormal GnRH pulsation causes high LH/FSH ratio |
| Why high LH/FSH ratio important in anovulation/PCOS | ovulation stimulated when follicle not ready |
| ovulation (anovulation) | follicle retained as cyst |
| What’s LH do? | Stimulates theca interna cells (females) and Leydig cells (males) to make androgens |
| What’s FSH do? | Stimulates granulosa cells (females) and Sertoli cells (males) to make aromatase; also |
| primes follicles | |
| Tx for PCOS | if high BMI, weight loss first always on USMLE |
| Tx for PCOS if they ask for meds and/or weight loss already tried | OCPs (if not wanting pregnancy); |
| clomiphene (if wanting pregnancy) | |
| PCOS increases risk of what | endometrial cancer (unopposed estrogen) |
| Tx of prostate cancer | flutamide + leuprolide together (if they force a sequence, choose F then L). |
| Tx of acute gout | indomethacin (NSAID) first on USMLE; then steroids, then colchicine |
| Tx of acute gout if indomethacin + steroids not listed | colchicine |
| Tx of acute gout in pt with renal insufficiency or Hx of renal transplant | steroids |
| Tx of chronic gout (decrease recurrence) | allopurinol or febuxostat (xanthine oxidase inhibitors) |
| Never give which drug to pt with Hx of uric acid stones or over-producer | probenecid (uricosuric) |
| What are rasburicase / pegloticase | urate oxidase analogues |
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| Young kid + self-mutilation + red-orange crystals in diaper | Lesch-Nyhan syndrome (X-linked) Lesch-Nyhan enzyme |
| Crystal type in pseudogout | calcium pyrophosphate deposition disease |
| Two main causes of pseudogout | primary hyperparathyroidism + hemochromatosis |
| Two ways pseudogout presents | monoarthritis of large joint (i.e., knee) or osteoarthritis-like presentation in someone with primary hyperparathyroidism or hemochromatosis |
| 32M + dark skin on forearms + increased fasting glucose; Dx? | hemochromatosis (bronze diabetes) |
| Same male + painful hands + x-ray shows DIP involvement. Joint pain Dx? | pseudogout |
| Tx of pseudogout | same as gout acutely; Tx underlying condition for chronic |
| Biggest risk factor for osteoarthritis | obesity |
| Tx of osteoarthritis | weight loss; if normal BMI |
| Patient with OA taking naproxen (NSAID) + peripheral edema | increased renal retention of sodium |
| Patient taking NSAID + edema; why? | NSAID decreases renal blood flow |
| compensate for perceived low volume status | water follow sodium |
| Tx of rheumatoid arthritis | Two-armed: symptom-relief + disease-modifying anti-rheumatic drugs (DMARDs) |
| Symptom-relief for RA | NSAID first, then steroids (these do symptoms only; do not slow disease progression) |
| DMARDs for early RA | always methotrexate first; if insufficient, add another DMARD (sulfasalazine or |
| leflunomide); if insufficient add anti-TNF-alpha agent | |
| Methotrexate MOA | dihydrofolate reductase inhibitor |
| Methotrexate side-effects | pulmonary fibrosis + hepatotoxicity + mouth ulcers (neutropenia) |
| Sulfasalazine MOA | metabolized into sulfapyridine + mesalamine in the gut by bacteria |
| Mesalamine is 5-ASA absorbed as the Tx for RA; only NSAID considered to be DMARD | |
| Leflunomide MOA | dihydroorotate dehydrogenase inhibitor (pyrimidine synthesis) |
| Most specific Abs in RA | anti-CCP (cyclic citrullinated peptide), not RF (rheumatoid factor) |
| X-ray of hands in RA vs OA | Only OA has DIPs involved; RA is PIPs + MCPs |
| Symmetry in RA vs OA | RA is symmetrical; OA is not |
| Any pt with red, warm, tender knee | joint aspiration (arthrocentesis); septic arthritis till proven otherwise |
| Biggest risk factor for septic arthritis | abnormal joint architecture |
| Pt groups most likely to get SA | prosthetic joints, RA/OA, recent intense exercise/joint trauma; peds (JRA) MEHLMANMEDICAL.COM 17 |
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| Pt group most likely to get SA | those with prosthetic joints (can’t be more abnormal than fake joint) Pt with OA or RA has red, warm, tender knee |
| 17F had kickboxing tournament last weekend + knee is red, warm, tender | arthrocentesis (SA) |
| Kid + recurrent knee redness, warmth, pain + fever | Juvenile rheumatoid arthritis (JRA; Still disease) Kid + recurrent joint pain +/- high ESR +/- rash |
| Kid + recurrent joint pain + anemia | JRA (anemia of chronic disease) |
| Kid with suspected JRA has sore knee | must do arthrocentesis to rule out septic arthritis |
| Most common presentation finding in SLE | arthritis (>90%) |
| Woman 20s-40s + arthritis + thrombocytopenia | SLE |
| Woman 20s-40s + arthritis + mouth ulcer + circular skin lesions | SLE |
| Malar rash + low RBCs + low WBCs + low platelets; mechanism for low cell lines? | increased peripheral destruction (antibodies against hematologic cells lines seen in SLE; isolated thrombocytopenia most common) Tx of SLE flare |
| SLE + red urine; Dx? | lupus nephritis, more specifically, diffuse proliferative glomerulonephritis (DPGN) Histology of DPGN |
| Tx of lupus nephritis | mycophenolate mofetil |
| Tx of discoid lupus | hydroxychloroquine |
| Most specific Abs for SLE | anti-Smith (RNP), not anti-dsDNA |
| Which Abs go up in acute SLE flares | anti-dsDNA (and C3 goes down) |
| Drug-induced lupus Abs | anti-histone |
| Drugs that cause DIL | Mom is HIPP |
| Viral infection + all three cell-lines are down | viral-induced aplastic anemia |
| Viral-induced aplastic anemia; next best step in Dx? | bone marrow aspiration |
| Viral-induced aplastic anemia; mechanism? | defective bone marrow production (contrast with SLE) |
| Viral infection + low platelets | ITP (immune thrombocytopenic purpura) |
| Woman 30s-40s with random bruising at different stages of healing | (also ITP; first rule out abuse) Mechanism of ITP |
| Dx of ITP | answer = low platelet count; don’t choose increased bleeding time |
| ITP Tx | steroids first, then IVIG, then splenectomy |
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| ITP episode | next best step in management |
| ITP episode | most effective way to decrease recurrence |
| Family Hx of heme condition treated with splenectomy | hereditary spherocytosis (autosomal dominant) |
| Bleeding time meaning? | platelet problem |
| PT and aPTT meaning? | clotting factor problem |
| Heme findings in ITP | increased BT, normal PT, normal aPTT |
| Heme findings in hemophilia | increased aPTT; bleeding time and PT are normal |
| Cause of hemophilia | X-linked recessive; hemophilia A (factor VIII def); hemophilia B (factor IX def) |
| Tx of hemophilia A | desmopressin for hemophilia A (increases VIII release); then give factor VIII |
| Tx of hemophilia B | give factor IX |
| Classic hemophilia presentation | hemarthrosis in school-age boy; bleeding after circumcision in neonate |
| Inheritance pattern of vWD | AD |
| Heme findings in vWD | bleeding time always high; PT always normal; aPTT elevated half the time |
| What is main function of vWF? | bridges platelet GpIb to underlying collagen (adhesion, not aggregation) |
| What is secondary function of vWF | stabilizes factor VIII in plasma (that’s why aPTT only half time increased) |
| vWD presentation | always one platelet problem + one clotting factor problem |
| Platelet problem? | epistaxis, bruising, petechiae |
| Clotting factor problem | menorrhagia, excessive bleeding with tooth extraction, hemarthrosis (but |
| hemarthrosis very very rare in vWD; it is seen in hemophilia) | |
| vWD treatment | desmopressin |
| Vitamin K deficiency heme parameters? | Increased PT + aPTT; bleeding time normal |
| Cause of vitamin K deficiency in adults | chronic Abx knock out colonic flora |
| Cause of sickle cell | glutamic acid to valine mutation on beta-chain |
| Inheritance of sickle cell | AR |
| Nephrotic syndrome in SS | FSGS |
| Dark urine in SS | renal papillary necrosis |
| HY drugs that cause agranulocytosis | clozapine, ganciclovir, propylthiouracil, methimazole, methotrexate, |
| ticlopidine | |
| How will agranulocytosis (neutropenia) present on USMLE? | mouth ulcers + fever MEHLMANMEDICAL.COM 19 |
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| Tx for febrile neutropenia / neutropenic fever | immediate broad-spectrum IV Abx Broad-spectrum Abx example? |
| PTU and methimazole are used for what? | Tx of Graves |
| Ticlopidine is what? | ADP2Y12 blocker anti-platelet agent (clopidogrel, prasugrel, ticagrelor also) |
| Strongest indication for anti-coagulation | prosthetic material in heart / prosthetic valve (factoid in isolation) |
| Travel + self-limiting watery or brown/green diarrhea | Traveler diarrhea = ETEC HL or HS toxin |
| Abx (clindamycin, beta-lactam, cephalosporin) + diarrhea | C. difficile |
| Dx of C. diff | stool AB toxin test, not stool culture |
| Fever of 104 + abdo distension in C diff | toxic megacolon |
| Tx of C. diff | vancomycin, not metronidazole (updated guidelines as of Feb 2018) |
| Bloody diarrhea + travel | Entamoeba histolytica |
| Tx of E. histolytica | metronidazole + iodoquinol; can give paromomycin |
| Close quarters or military barracks or cruise ship + watery diarrhea | Norwalk virus |
| Child <5 years + watery diarrhea | rotavirus |
| Few organisms causing bloody diarrhea | Shigella |
| Bloody diarrhea + appendicitis-like pain (pseudoappendicitis) in a child | Yersinia enterocolitica |
| Bloody diarrhea + reactive arthritis in an adult | Y. enterocolitica, Campylobacter, Shigella, Salmonella |
| Diarrhea + Guillain-Barre syndrome | Campylobacter |
| GBSyndrome CSF? | albuminocytologic dissociation (high protein + normal cells) |
| GBSyndrome Dx? | electromyography + nerve conduction studies (on NBME) |
| Cardiac ischemia + need to evaluate | ECG stress test first-line |
| Cardiac ischemia + abnormal baseline ECG (e.g., BBB) | Echo stress test (need normal ECG to do ECG stress test) |
| Cardiac ischemia + patient can’t exercise | dobutamine + ECG/echo |
| ECG shows diffuse ST-segment elevations | pericarditis |
| Pericarditis Tx | NSAID, or steroid, or colchicine |
| Central chest pain worse when supine; better when leaning forward | pericarditis |
| Lateral chest pain after viral infection + increased CK | pleurodynia (intercostal muscle spasm) |
| ST-segment depressions in the anterior ECG leads | posterior MI |
| Electrical alternans on ECG | pericardial tamponade / pericardial effusion |
| Pulsus paradoxus (drop in systolic BP >10 mm with inspiration) | cardiac tamponade or severe asthma |
| Beck triad | hypotension + muffled heart sounds + JVD |
| Bloody diarrhea + poultry consumption | Campylobacter jejuni or Salmonella spp. |
| Tx of tamponade | pericardiocentesis or pericardial window |
| Tamponade | do echo before pericardiocentesis if both listed (even though sounds wrong, on 2CK NBME) |
| CPP + lobar pattern (right-lower lobe consolidation + dullness to percussion) | Strep pneumo |
| CPP + lobar pattern, but they say “interstitial” in the vignette description | Mycoplasma, not S. pneumo Empiric Tx for CPP |
| Tx for CPP is pt on Abx past three months | fluoroquinolone over azithro |
| Pneumonia in CF patient <10 years | S. aureus exceeds Pseudomonas |
| Pneumonia in CF patient >10 years | Pseudomonas exceeds S. aureus. |
| Pneumonia after influenza infection | USMLE wants S. aureus |
| Pneumonia + rabbits | F. tularensis |
| Pneumonia + cattle | Coxiella (Q fever) |
| Pneumonia + birds | Chlamydia psittaci |
| Leg swelling + pain + shortness of breath | Pulmonary embolism caused by DVT |
| Tx of PE | Heparin before spiral CT |
| Tx of PE in pregnant woman | V/Q scan, not CT |
| Tx of PE in someone already on warfarin | spiral CT to confirm, then IVC filter |
| Acid-base disturbance in PE | resp. alkalosis (low CO2, high pH, low O2, normal bicarb [too acute to change]) Acid-base disturbance in asthma |
| Acid-base disturbance in aspirin toxicity first 20 mins | resp. alkalosis (low CO2, high pH, normal O2, normal bicarb [too acute to change]) |
| Acid-base disturbance in aspirin toxicity after 20 mins | mixed metabolic acidosis-respiratory alkalosis (low CO2, low pH, normal O2, low bicarb) |
| Tx for aspirin toxicity | bicarb (increased excretion through urinary alkalinization) |
| Tx for TCA toxicity | sodium bicarb |
| Normal calcium | 8.4-10.2 mEq/L |
| Tx of hypercalcemia | 10.2-12 -> normal saline (0.9% NaCl) |
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| Community-acquired pneumonia (CPP) + bilateral CXR infiltrates | Mycoplasma |
| Tx of hypercalcemia | 12-14 -> normal saline (0.9% NaCl) only if asymptomatic; add bisphosphonate (e.g., pamidronate) if symptomatic |
| Tx of hypercalcemia | 14+ -> normal saline (0.9% NaCl) + bisphosphonate |
| High calcium + polyuria | nephrogenic diabetes insipidus (weird, but on NBME) |
| High calcium + confusion | delirium caused by high calcium |
| Low calcium or potassium not responsive to supplementation | cause is low Mg |
| Low calcium or potassium in alcoholic | hypomagnesemia is cause |
| Ataxia, confusion, ophthalmoplegia | Wernicke encephalopathy (B1 deficiency) |
| Retrograde amnesia + confabulation in alcoholic | Korsakoff psychosis |
| Wernicke-Korsakoff syndrome | mammillary bodies |
| Hx of many pregnancies + downward movement of vesicourethral junction | stress incontinence |
| Tx of stress incontinence | pelvic floor exercises (Kegel); if insufficient |
| Hyperactive detrusor or detrusor instability | urge incontinence |
| Need to run to bathroom when sticking key in a door | urge incontinence |
| Incontinence in multiple sclerosis patient or perimenopausal | urge incontinence |
| Tx of urge incontinence | oxybutynin (muscarinic cholinergic antagonist) or mirabegron (beta-3 agonist) Incontinence + high post-void volume (usually 3-400 in question; normal is <50 mL) |
| Tx for overflow incontinence in diabetes | bethanacol (muscarinic cholinergic agonist) |
| Incontinence in BPH | overflow incontinence due to outlet obstruction |
| Tx for overflow incontinence in BPH | insert catheter first; then give alpha-1 blocker of 5-alpha-reductase inhibitor; then TURP if necessary |
| Exquisitely tender prostate on digital rectal exam | prostatitis |
| Prostatitis Tx | ciprofloxacin (fluoroquinolone |
| Costovertebral angle tenderness + fever | pyelonephritis |
| Costovertebral angle tenderness + granular casts | pyelonephritis (correct, super-weird; NOT acute tubular necrosis; this is on 2CK NBME) |
| Tx for pyelonephritis | ciprofloxacin, OR ampicillin + gentamicin |
| Saddle anesthesia + urinary retention | cauda equina syndrome |
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| Perianal anesthesia + urinary retention or incontinence | conus medullaris syndrome |
| Gradual-onset dementia + no sensory or motor dysfunction | Alzheimer |
| Mini-mental state exam score low + patient tries to do well | Alzheimer |
| Mini-mental state exam score low + patient is apathetic / takes long to perform tasks / does poorly on reverse serial 7s | depression (pseudodementia) |
| Patient complains about memory loss | normal aging, not Alzheimer |
| First-line Tx for Alzheimer | donepezil (cholinesterase inhibitor also give galantamine or rivastigmine |
| NMDA receptor (glutamate receptor) antagonist used in Alzheimer Tx | memantine |
| Step-wise dementia/decline and/or sensory/motor disturbance | vascular dementia |
| Hx of hypertension + dementia + sensory/motor disturbance | vascular dementia |
| Visual hallucinations + Parkinsonism + dementia | Lewy body dementia |
| Apathy + disinhibition + personality change + dementia | frontotemporal dementia (Pick disease) |
| Urinary incontinence + ataxia + CNS dysfunction (wet, wobbly, wacky) | Normal-pressure hydrocephalus |
| Wet, wobbly, wacky + Parkinsonism | still NPH |
| Parkinsonism in young patient | Wilson disease till proven otherwise |
| Parkinsonism in older patient | Parkinson disease |
| Parkinsonism + axial dystonia | progressive supranuclear palsy |
| Tx of UTI | TMP/SMX or nitrofurantoin |
| Tx of cystitis | nitrofurantoin (need not be pregnant) |
| Waiter tip position in kid | upper brachial plexus injury |
| Claw hand | lower brachial plexus |
| Pronated arm + wrist-drop | radial nerve injury |
| Midshaft fracture of humerus | Radial nerve injury |
| Supracondylar fracture of humerus | median nerve injury |
| Surgical neck of humerus fracture | axillary nerve injury |
| Medial epicondylar injury | ulnar nerve injury |
| Weakened biceps + loss of sensation of lateral forearm | musculocutaneous nerve injury |
| Paresthesias + pain following burn or casting | compartment syndrome |
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| Compartment syndrome Dx | measure compartment pressure |
| Compartment syndrome Tx | fasciotomy of uncast |
| Guy lifts heavy box | severe lower back pain + muscle spasm + no radiculopathy |
| Lumbosacral strain diagnosis | DO NOT x-ray |
| Lumbosacral strain Tx | NSAIDs + exercise as tolerated; bedrest is the WRONG answer |
| Guy lifts heavy box | severe lower back pain + radiculopathy |
| Point tenderness over a vertebra in older woman | osteoporosis (compression fracture) |
| Point tenderness over a vertebra in younger patient on steroids | osteoporosis (compression fracture) |
| Point tenderness over a vertebra in patient with autoimmune disease | recognize patient is on steroids -> osteoporosis (compression fracture) |
| Point tenderness over a vertebra in IV drug user | epidural abscess |
| “Step-off” of one vertebra relative to another | spondylolisthesis |
| Back pain worse in the morning and gets better throughout day in male 20s-40s | ankylosing spondylitis |
| Bamboo spine | ankylosing spondylitis |
| Dx of AS | x-ray of sacroiliac joints |
| Back pain worse when standing or walking for long periods of time | lumbar spinal stenosis |
| Radiculopathy down an arm | cervical disc herniation |
| Bilateral paresthesias in the arms in rheumatoid arthritis patient | atlantoaxial subluxation |
| Bilateral paresthesias in the arms in rheumatoid arthritis patient | MR of spine to Dx atlantoaxial subluxation |
| Prior to surgery in rheumatoid arthritis patient | cervical CT or flexion/extension x-rays of cervical spine to check for atlantoaxial subluxation |
| Back pain in elderly patient with hypercalcemia | multiple myeloma or metastases |
| Back in pain in patient with history of other type of cancer | metastases |
| Suspected spinal mets | MRI |
| Metastases to long bones in prostate cancer | osteoblastic (Dx with bone scan); spine do MRI |
| High hemoglobin +/- pruritis after shower +/- plethora +/- splenomegaly | polycythemia vera |
| High hemoglobin + low EPO | polycythemia vera |
| Pruritis after shower | basophilia |
| High hemoglobin + lung disease / low pO2 | secondary polycythemia (high EPO) |
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| Polycythemia + hypercalcemia + smoker + red urine | RCC (paraneoplasic EPO + PTH-rp) |
| Blurry vision or Raynaud or pain in fingers or headache | hyperviscosity syndrome Hyperviscosity syndrome |
| Hereditary spherocytosis | AD, ankyrin or spectrin or band protein deficiency; Tx = splenectomy Treatment for ITP |
| Tx for hereditary hemochromatosis | serial phlebotomy |
| Tx for secondary hemochromatosis (transfusional siderosis) | chelation therapy (deferoxamine) |
| Viral infection + tinnitus + vertigo +/- neurosensory hearing loss | labrynthitis |
| Viral infection + vertigo | vestibular neuritis |
| Tx for multiple sclerosis flares | IV steroids (IV methylprednisolone) |
| Given to MS patients between flares | interferon-beta |
| Tx for spasticity in MS | baclofen (GABA-B receptor agonist) |
| Incontinence in MS | urge (hyperactive detrusor, as mentioned earlier) |
| New-onset murmur + fever | endocarditis till proven otherwise |
| Empiric Tx for endocarditis | vancomycin or ampicillin/sulbactam, PLUS gentamicin |
| Beta-lactam (e.g., nafcillin) or cephalosporin + rash + renal issue | interstitial nephritis |
| Interstitial nephritis | WBCs in the urine (eosinophils) |
| Fixed splitting of S2 | atrial septal defect |
| Holosystolic murmur at left sternal border PLUS either parasternal heave or palpable thrill | VSD |
| Holosystolic murmur at left sternal border PLUS diastolic rumble | also VSD |
| To-and-fro murmur | PDA (on 2CK NBME) |
| Pan-systolic-pan-diastolic murmur | PDA |
| Continuous, machinery-like murmur | PDA |
| Congenital rubella syndrome | PDA |
| Heart problem in neonate of mom with SLE | congenital third-degree heartblock |
| Heart problem in William syndrome | supravalvular aortic stenosis |
| Bicuspid aortic valve | aortic stenosis |
| Mid-systolic (crescendo-decrescendo) murmur + gets worse with Valsalva | HOCM |
| Mid-systolic (crescendo-decrescendo) murmur + no change or softens with Valsalva | aortic stenosis MEHLMANMEDICAL.COM 8 |
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| Myxomatous degeneration of mitral valve | mitral valve prolapse |
| Marfan or Ehlers-Danlos syndrome | MVP or aortic regurg |
| Rheumatic heart disease acutely (onset of Group A Strep infection) | mitral regurg |
| Rheumatic heart disease later on (years after infection) | mitral stenosis |
| Mid-systolic click | MVP |
| Late-peaking systolic murmur with ejection click | another way they describe aortic stenosis |
| Bounding pulses + massively wide pulse pressure | aortic regurg |
| Brisk upstroke + precipitous downstroke of pulse | aortic regurg |
| Syncope + angina + dyspnea (SAD) | aortic stenosis |
| Dyspnea in second trimester of pregnancy | mitral stenosis |
| Dyspnea late in pregnancy | peripartum cardiomyopathy |
| Screening at age 50 | mammogram (every two years) + colonoscopy (every ten years) |
| Colon cancer in first-degree relative (sibling or parent) | start at age 40 or ten years before diagnosis in relative, whichever is earlier, and do every 5 years. |
| Breast imaging (if performed) | ultrasound only under age 30; over age 30 do mammogram +/- ultrasound |
| Anuria (no urine output) after removal of catheter | acute urethral obstruction |
| Contrast induced nephropathy; how to prevent | saline hydration beforehand |
| BUN/Cr > 20 | prerenal (hypovolemia) |
| BUN/Cr <20 | not prerenal (15-20 for post-renal, and <15 for intra-renal is wrong on 2CK NBMEs) |
| Blood loss + oliguria | acute tubular necrosis |
| Blood loss + obstetric catastrophe | diffuse cortical necrosis |
| Sickle cell + nephrotic syndrome | focal segmental glomerulosclerosus |
| Sickle cell + red urine | renal papillary necrosis |
| 2+ blood in urine but 0-4 RBCs/HPF on LM | false + blood on dipstick |
| Pleural / supradiaphragmatic plaques | asbestosis |
| Preferred antibiotic in sepsis | ceftriaxone |
| Sepsis Tx in young children | cefotaxime |
| Tx for spontaneous bacterial peritonitis | ceftriaxone |
| Cirrhosis or recent peritoneal dialysis or nephrotic syndrome + fever + abdo pain | SBP |
| Dysphagia to solids and liquids at the same time to start | says neurogenic cause |
| Dysphagia to solids that progresses to solids and liquids | esophageal cancer |
| Halitosis +/- gurgling sound when swallowing +/- regurgitation of undigested food | Zenker |
| Zenker + achalasia initial Dx modality | barium swallow |
| After barium swallow is done and shows bird’s beak appearance | monometry to confirm Dx of achalasia |
| Pt with Hx of GERD + dysphagia | straight to endoscopy to rule out cancer |
| Diabetic pt with new-onset GERD | diabetic gastroparesis |
| Diabetic pt with new-onset GERD | give metoclopramide, not PPI |
| Diabetic gastroparesis before giving med | endoscopy first to rule out physical obstruction |
| Endoscopy negative for diabetic gastroparesis | do gastric-emptying scintigraphy |
| Bulimia nervosa or anorexia | never give buproprion (seizure risk) |
| Electrolyte abnormality in anorexia | hypokalemia |
| Most common cause of death in anorexia | arrhythmia from hypokalemia |
| Refeeding syndrome | worry about hypophosphatemia |
| Tx of anorexia + depression | mirtazapine (alpha-2 antagonist); stimulates appetite |
| Amenorrhea in anorexia | low FSH + low estrogen (hypogonadotropic) |
| Premature ovarian failure + Turner syndrome + menopause | high FSH (low inhibin) + low estrogen |
| Cholelithiasis | Dx with abdo ultrasound; fat, forties, female, fertile |
| Biliary colic + fever | cholecystitis |
| Tx of cholelithiasis + cholecytitis | cholecystectomy |
| Pt doesn’t want surgery or is pregnant | ursodeoxycholic acid (ursodiol) |
| Abdo USS negative in suspected cholecystitis | HIDA scan |
| Gall bladder doesn’t light up on HIDA scan | confirms cholecystitis |
| Cholelithiasis in pregnancy | estrogen upregulates HMG-CoA reductase + progesterone slows biliary peristalsis |
| Trichotillomania (eating one’s hair) + GI symptoms | gastric bezoar (hair ball) |
| Hx of surgery + high-pitched bowel sounds or acute-onset abdo symptoms | small bowel obstruction (SBO) |
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| Renal failure + friction rub over chest | uremic pericarditis |
| High leukocytes + low leukocyte ALP | CML |
| Metamyelocytes + myelocytes + splenomegaly | CML |
| Tx of CML | imatinib; causes fluid retention / edema |
| Smudge cells + autoimmune hemolytic anemia | CLL |
| Auer rods | AML; composed of myeloperoxidase |
| Tx of AML | DIC caused by Auer rod release into blood |
| Kid with high lymphocytes | ALL or pertussis (weird bc bacterial, but lymphocytes often >30k) Dry cough in winter |
| Young African American woman + dry cough + normal CXR | asthma (activation of mast cells), not sarcoidosis Young African American woman + dry cough + nodularity on CXR |
| Hypercalcemia in sarcoid, why? | epithelioid (activated) macrophages produce 1-alpha hydroxylase, thereby activating vitamin D3 |
| Increased calcium in sarcoid | means decreased calcium in feces (bc D3 increased small bowel absorption) Tx for sarcoid |
| Outpatient Tx of asthma | SABA, then low-dose ICS, then maximize dose of ICS, then LABA, then use any number of drugs (e.g., mast cell stabilizers, anti-leukotriene, etc.), then oral steroids last resort |
| Kid with asthma on SABA inhaler + not effective + next best step? | ICS (fluticasone) |
| Kid with asthma on SABA inhaler + most effective way to decrease recurrence? | oral steroids (not next best step, but certainly most effective) |
| 40s male + hematuria + hemoptysis | Goodpasture syndrome |
| Antibodies in Goodpasture | Anti-GBM (anti-collagen IV) |
| Dx of Goodpasture | antibodies first, but confirmatory is renal biopsy showing linear immunofluorescence Hematuria + hemoptysis + “head-itis” (mastoiditis, sinusitis, otitis, nasal septal perforation) |
| New name for Wegener | granulomatosis with polyangiitis |
| Dx of Wegener | c-ANCA (anti-PR3; anti-proteinase 3) |
| Asthma + eosinophilia | Churg-Strauss |
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| New name for Churg strauss | eosinophilic granulomatosis with polyangiitis |
| Dx of CS | p-ANCA (anti-MPO; anti-myeloperoxidase) |
| Hematuria in isolation + p-ANCA in serum | microscopic polyangiitis (MP) |
| Severe renal disease in Wegener or Goodpasture or MP | rapidly progressive glomerulonephritis (crescentic) High ALP + high direct bilirubin + high amylase or lipase |
| High ALP + high direct bilirubin + high amylase or lipase + remote Hx of cholecystectomy | sphincter of Oddi dysfunction (can’t be a stone cuz the gallbladder was removed ages ago) |
| High ALP + high direct bilirubin + normal amylase or lipase in someone with recent cholecystectomy | choledocholithiasis (retained stone in cystic duct that descended, but not distal to pancreatic duct entry point) Dx and Tx of choledocholithiasis |
| High ALP + high direct bilirubin + normal amylase or lipase in someone with remote cholecystectomy | pancreatic cancer |
| Dx of pancreatic cancer | CT abdo with contrast |
| High ALP + high direct bilirubin + normal amylase or lipase in someone with remote cholecystectomy + CT is negative | cholangiocarcinoma |
| High ALP + high direct bilirubin + normal amylase or lipase + diffuse pruritis + high cholesterol | primary biliary cirrhosis (PBC) |
| High ALP + high direct bilirubin + normal amylase or lipase + autoimmune disease (in pt or family) | PBC Dx of PBC |
| Recent cholecystectomy + fever + abdo pain | post-op bile leak |
| High ALP + high direct bilirubin + normal amylase or lipase + CT shows cystic lesion in bile duct | choledochal cyst |
| Imaging to view liver or pancreas | CT with contrast |
| Imaging to view gallbladder | Ultrasound |
| Imaging to view gallbladder in suspected cholecystitis only if USS negative | HIDA scan |
| Imaging to view bile ducts | ERCP or MRCP (choose ERCP > MRCP if both listed) |
| Teenage girl with Hx of cutaneous candida infections since childhood | chronic mucocutaneous candidiasis MCC |
| Bacterial + fungal + protozoal + viral infections since birth | SCID |
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| Bacterial infections since age 6 months | Bruton |
| Bacterial infections only since birth | Bruton (rare as hell to say from birth, but it’s on new 2CK NBME) |
| SCID XR variant | common gamma-chain mutation (IL-2 receptor deficiency) |
| SCID AR variant | adenosine deaminase deficiency |
| Bruton mechanism | tyrosine kinase mutation |
| Hyper IgM syndrome | deficiency of CD40 ligand on T cell (can’t activate CD40 on B cell to induce isotype class switching) |
| Greasy, scaly scalp + itchy + papules + adult | seborrheic dermatitis |
| Tx for SD | azole or selenium shampoo |
| Tx for tinea capitis | oral griseofulvin for patient only |
| How to decrease risk of tinea capitis | avoidance of sharing of hats |
| Tx of onychomycosis (nailbed fungus) | oral terbinafine |
| Tx of tinea pedis | topical terbinafine or topical azole |
| Tx of tinea corporis (ring worm) | topical azole (clotrimazole or miconazole) |
| Tx of cutaneous candida | oral azole |
| Tx of oropharyngeal candida | nystatin mouthwash |
| Tx of esophageal candidiasis | oral azole, not nystatin mouthwash |
| Tx of vaginal candidiasis | topical nystatin before trying oral azole |
| Odynophagia (painful swallowing) in immunocompromised pt | esophageal candidiasis till proven otherwise |
| CNS fungal infection or fungemia (rigors/chills) | amphotericin B |
| Cryptococcal meningitis | amphotericin B + flucytosine, then do fluconazole taper |
| Simple fungal pneumonia | fluconazole |
| Sporothrix schenckii (rose thorn + finger papule) | itraconazole |
| Hypopigmentation on upper back / trunk | tinea versicolor (Malassezia furfur) |
| Tx of tinea versicolor | topical selenium |
| Most common cause of impetigo | S. aureus now exceeds S. pyogenes |
| Tx of impetigo | topical mupirocin |
| Beefy red, well-demarcated skin plaque | erysipelas |
| Most common cause of erysipelas | Group A Strep (S. pyogenes) >>> S. aureus |
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| More diffuse pink skin lesion + tenderness + fever | cellulitis |
| Most common cause of cellulitis | S. aureus exceeds S. pyogenes |
| Tx of erysipelas + cellulitis | oral dicloxacillin or oral cephalexin |
| Wide-complex tachyardia | ventricular tachycardia (VT) |
| Narrow-complex tachy | SVT |
| Tx for SVT | vagal/carotid massage first; if doesn’t work, then adenosine |
| Tx of VT | anti-arrhythmics, e.g., amiodarone |
| Tx of SVT or VT in setting of coma / unconsciousness | direct-current countershock |
| Tx of first-degree heartblock or second-degree Mobitz I (Wenckebach) | observe |
| Tx of second-degree Mobitz II or third-degree heartblock | pacemaker |
| First-degree heartblock | PR-interval >200 milliseconds |
| Mobitz I | gradually prolonging PR-interval before a QRS drops |
| Mobitz II | no gradual prolongation of PR-interval; QRS randomly drops |
| Third-degree | HR super slow at 30-40; no relation between p-waves and QRS complexes |
| Infective causes of third-degree | Lyme disease, congenital lupus, diphtheria |
| Give killed IM influenza vaccine when? | Every year in fall/winter only; start from 6 months of age |
| Killed IM Influenza vaccine safe in pregnancy? | Yes, give anytime to pregnant women |
| Live-attenuated intranasal influenza vaccine guidelines? | Only give age 2-49 to non-pregnant, non- immunocompromised persons |
| Vaccines at age 2, 4, 6 months: HepB, Polio Salk, Pneumo PCV13, DPT, HiB, rotavirus (also give HepB at birth) HPV vaccine when | age 9-45 |
| Mom’s HepB status unknown | give neonate HepB vaccine; only give immunoglobulin if mom comes back + MMR |
| Varicella | one dose between 12-18 months |
| Age 65 or older | give Pneumo PCV13 followed by PPSV23 6-12 months later |
| Asplenia or sickle cell | PCV13 + PPSV23 + HiB + Meningococcal |
| Circular lesion in pancreas seen in pancreatitis | pseudoabscess |
| Centri-acinar emphysema | smokers |
| Pan-acinar emphysema | alpha-1 anti-trypsin deficiency |
| Young adult + non-smoker + has emphysema + relative died of hepatic cirrhosis | alpha-1 anti-trypsin deficiency |
| CREST syndrome lung pathology? | can cause pulmonary fibrosis |
| Restrictive lung disease | normal or increased FEV1/FVC |
| Obstructive lung disease | decreased FEV1/FVC |
| Why is FEV1/FVC normal or high in restrictive? | radial traction on outside of airways is sticky (keeps airways from closing) |
| Apex to base lung changes when sitting/standing | both ventilation + perfusion increase apex to base |
| Most common cause of otitis media | Strep pneumo |
| Tx of otitis media | oral amoxicillin only |
| Tx of recurrent OM | amoxicillin/clavulanate |
| When to do tympanostomy tube | three or more OM in 6 months, or 4 or more in a year |
| Most common cause of otitis externa | Pseudomonas |
| Tx of otitis externa | topical ciprofloxacin + hydrocortisone drops |
| Prevention of OE in someone with constant water exposure (e.g., crew team) | alcohol-acetic acid drops |
| Tx of earwax buildup | carbamide peroxide drops |
| Low hematocrit + low MCV + low transferrin + low TIBC + transferrin saturation normal or low | anemia of chronic disease |
| Low hematocrit + low MCV + high transferrin + high TIBC + transferrin saturation super-low | iron deficiency anemia |
| Low hematocrit + low MCV + increased red cell distribution width (RDW) | iron deficiency anemia |
| Low hematocrit + low MCV + low iron + low ferritin | iron deficiency |
| Low hematocrit + low MCV + normal iron + normal or high ferritin | thalassemia |
| iron deficiency anemia + low MCV + low/low-normal RDW | thalassemia |
| Microcytic anemia that doesn’t improve with iron supplementation | thalassemia |
| Low hematocrit + normal MCV + low iron + normal or high ferritin | anemia of chronic disease |
| Tx of anemia of chronic disease if renal failure is cause | answer = EPO |
| Tx of anemia of chronic disease if renal failure not cause (IBD, RA, SLE, etc.) | CANNOT give EPO; Tx underlying condition. |
| Dx of thalassemia + low MCV + normal iron + normal ferritin in pregnant woman on iron supplements | thalassemia |
| High BP + smoker + TIA or stroke or retinal artery occlusion. How to best decrease stroke risk | Answer = lisinopril, not smoking cessation |
| Normotensive old pt + TIA or stroke or retinal artery occlusion | atrial fibrillation |
| Hypertensive pt + stroke | do carotid duplex ultrasound |
| Normotensive pt + stroke | do ECG; if ECG normal |
| High BMI female + irregular menstrual cycles | anovulation |
| Anovulation + hirsutism | PCOS |
| Anovulation. Cause USMLE wants? | insulin resistance |
| Why hirsutism in anovulation | abnormal GnRH pulsation causes high LH/FSH ratio |
| Why high LH/FSH ratio important in anovulation/PCOS | ovulation stimulated when follicle not ready |
| ovulation (anovulation) | follicle retained as cyst |
| What’s LH do? | Stimulates theca interna cells (females) and Leydig cells (males) to make androgens |
| What’s FSH do? | Stimulates granulosa cells (females) and Sertoli cells (males) to make aromatase; also primes follicles |
| Tx for PCOS | if high BMI, weight loss first always on USMLE |
| Tx for PCOS if they ask for meds and/or weight loss already tried | OCPs (if not wanting pregnancy); clomiphene (if wanting pregnancy) |
| PCOS increases risk of what | endometrial cancer (unopposed estrogen) |
| Tx of prostate cancer | flutamide + leuprolide together (if they force a sequence, choose F then L). |
| Tx of acute gout | indomethacin (NSAID) first on USMLE; then steroids, then colchicine |
| Tx of acute gout if indomethacin + steroids not listed | colchicine |
| Tx of acute gout in pt with renal insufficiency or Hx of renal transplant | steroids |
| Tx of chronic gout (decrease recurrence) | allopurinol or febuxostat (xanthine oxidase inhibitors) |
| Never give which drug to pt with Hx of uric acid stones or over-producer | probenecid (uricosuric) |
| What are rasburicase / pegloticase | urate oxidase analogues |
| Young kid + self-mutilation + red-orange crystals in diaper | Lesch-Nyhan syndrome (X-linked) Lesch-Nyhan enzyme |
| Crystal type in pseudogout | calcium pyrophosphate deposition disease |
| Two main causes of pseudogout | primary hyperparathyroidism + hemochromatosis |
| Two ways pseudogout presents | monoarthritis of large joint (i.e., knee) or osteoarthritis-like presentation in someone with primary hyperparathyroidism or hemochromatosis |
| 32M + dark skin on forearms + increased fasting glucose; Dx? | hemochromatosis (bronze diabetes) |
| Same male + painful hands + x-ray shows DIP involvement. Joint pain Dx? | pseudogout |
| Tx of pseudogout | same as gout acutely; Tx underlying condition for chronic |
| Biggest risk factor for osteoarthritis | obesity |
| Tx of osteoarthritis | weight loss; if normal BMI |
| Patient with OA taking naproxen (NSAID) + peripheral edema | increased renal retention of sodium |
| Patient taking NSAID + edema; why? | NSAID decreases renal blood flow |
| compensate for perceived low volume status | water follow sodium |
| Tx of rheumatoid arthritis | Two-armed: symptom-relief + disease-modifying anti-rheumatic drugs (DMARDs) |
| Symptom-relief for RA | NSAID first, then steroids (these do symptoms only; do not slow disease progression) |
| DMARDs for early RA | always methotrexate first; if insufficient, add another DMARD (sulfasalazine or leflunomide); if insufficient add anti-TNF-alpha agent |
| Methotrexate MOA | dihydrofolate reductase inhibitor |
| Methotrexate side-effects | pulmonary fibrosis + hepatotoxicity + mouth ulcers (neutropenia) |
| Sulfasalazine MOA | metabolized into sulfapyridine + mesalamine in the gut by bacteria |
| Mesalamine is | 5-ASA absorbed as the Tx for RA; only NSAID considered to be DMARD |
| Leflunomide MOA | dihydroorotate dehydrogenase inhibitor (pyrimidine synthesis) |
| Most specific Abs in RA | anti-CCP (cyclic citrullinated peptide), not RF (rheumatoid factor) |
| X-ray of hands in RA vs OA | Only OA has DIPs involved; RA is PIPs + MCPs |
| Symmetry in RA vs OA | RA is symmetrical; OA is not |
| Any pt with red, warm, tender knee | joint aspiration (arthrocentesis); septic arthritis till proven otherwise |
| Biggest risk factor for septic arthritis | abnormal joint architecture |
| Pt groups most likely to get SA | prosthetic joints, RA/OA, recent intense exercise/joint trauma; peds (JRA) |
| Pt group most likely to get SA | those with prosthetic joints (can’t be more abnormal than fake joint) Pt with OA or RA has red, warm, tender knee |
| 17F had kickboxing tournament last weekend + knee is red, warm, tender | arthrocentesis (SA) |
| Kid + recurrent knee redness, warmth, pain + fever | Juvenile rheumatoid arthritis (JRA; Still disease) Kid + recurrent joint pain +/- high ESR +/- rash |
| Kid + recurrent joint pain + anemia | JRA (anemia of chronic disease) |
| Kid with suspected JRA has sore knee | must do arthrocentesis to rule out septic arthritis |
| Most common presentation finding in SLE | arthritis (>90%) |
| Woman 20s-40s + arthritis + thrombocytopenia | SLE |
| Woman 20s-40s + arthritis + mouth ulcer + circular skin lesions | SLE |
| Malar rash + low RBCs + low WBCs + low platelets; mechanism for low cell lines? | increased peripheral destruction (antibodies against hematologic cells lines seen in SLE; isolated thrombocytopenia most common) Tx of SLE flare |
| SLE + red urine; Dx? | lupus nephritis, more specifically, diffuse proliferative glomerulonephritis (DPGN) Histology of DPGN |
| Tx of lupus nephritis | mycophenolate mofetil |
| Tx of discoid lupus | hydroxychloroquine |
| Most specific Abs for SLE | anti-Smith (RNP), not anti-dsDNA |
| Which Abs go up in acute SLE flares | anti-dsDNA (and C3 goes down) |
| Drug-induced lupus Abs | anti-histone |
| Drugs that cause DIL | Mom is HIPP |
| Viral infection + all three cell-lines are down | viral-induced aplastic anemia |
| Viral-induced aplastic anemia; next best step in Dx? | bone marrow aspiration |
| Viral-induced aplastic anemia; mechanism? | defective bone marrow production (contrast with SLE) |
| Viral infection + low platelets | ITP (immune thrombocytopenic purpura) |
| Woman 30s-40s with random bruising at different stages of healing | (also ITP; first rule out abuse) Mechanism of ITP |
| Dx of ITP | answer = low platelet count; don’t choose increased bleeding time |
| ITP Tx | steroids first, then IVIG, then splenectomy |
| ITP episode | next best step in management |
| ITP episode | most effective way to decrease recurrence |
| Family Hx of heme condition treated with splenectomy | hereditary spherocytosis (autosomal dominant) |
| Bleeding time meaning? | platelet problem |
| PT and aPTT meaning? | clotting factor problem |
| Heme findings in ITP | increased BT, normal PT, normal aPTT |
| Heme findings in hemophilia | increased aPTT; bleeding time and PT are normal |
| Cause of hemophilia | X-linked recessive; hemophilia A (factor VIII def); hemophilia B (factor IX def) |
| Tx of hemophilia A | desmopressin for hemophilia A (increases VIII release); then give factor VIII |
| Tx of hemophilia B | give factor IX |
| Classic hemophilia presentation | hemarthrosis in school-age boy; bleeding after circumcision in neonate |
| Inheritance pattern of vWD | AD |
| Heme findings in vWD | bleeding time always high; PT always normal; aPTT elevated half the time |
| What is main function of vWF? | bridges platelet GpIb to underlying collagen (adhesion, not aggregation) |
| What is secondary function of vWF | stabilizes factor VIII in plasma (that’s why aPTT only half time increased) |
| vWD presentation | always one platelet problem + one clotting factor problem |
| Platelet problem? | epistaxis, bruising, petechiae |
| Clotting factor problem | menorrhagia, excessive bleeding with tooth extraction, hemarthrosis (but hemarthrosis very very rare in vWD; it is seen in hemophilia) |
| vWD treatment | desmopressin |
| Vitamin K deficiency heme parameters? | Increased PT + aPTT; bleeding time normal |
| Cause of vitamin K deficiency in adults | chronic Abx knock out colonic flora |
| Cause of sickle cell | glutamic acid to valine mutation on beta-chain |
| Inheritance of sickle cell | AR |
| Nephrotic syndrome in SS | FSGS |
| Dark urine in SS | renal papillary necrosis |
| HY drugs that cause agranulocytosis | clozapine, ganciclovir, propylthiouracil, methimazole, methotrexate, ticlopidine |
| How will agranulocytosis (neutropenia) present on USMLE? | mouth ulcers + fever MEHLMANMEDICAL.COM 19 |
| Tx for febrile neutropenia / neutropenic fever | immediate broad-spectrum IV Abx Broad-spectrum Abx example? |
| PTU and methimazole are used for what? | Tx of Graves |
| Ticlopidine is what? | ADP2Y12 blocker anti-platelet agent (clopidogrel, prasugrel, ticagrelor also) |
| Strongest indication for anti-coagulation | prosthetic material in heart / prosthetic valve (factoid in isolation) |
Created by:
gracey4u