Help
Options
Term
chicken + bloody diarrhea
click to flip
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't know
Term
tx for entamoeba
Remaining cards (933)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
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 |
| MEHLMANMEDICAL.COM | |
| 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 |
| MEHLMANMEDICAL.COM | |
| 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 |
| MEHLMANMEDICAL.COM | |
| MEHLMANMEDICAL.COM 18 | |
| 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 |
| MEHLMANMEDICAL.COM | |
| 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) |
| 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 + 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