Alert Medical Series: USMLE Alert II

Ala Sarraj

Description

This series is a compilation of powerful high yield random notes and comparisons that will guarantee laser-sharp comprehensive and effective knowledge acquisition and high score passing rates in the fields of USMLE (US Medical Licensing Exam), Internal Medicine and Emergency Medicine boards.

Sujets

• Médecine
• Spécialités médicales
• Médecine d'urgence
• Emergency Medicine
• Medical

Informations

• Publié par: Outskirts Press
• Date de parution: 23 octobre 2016
• Nombre de lectures: 0
• EAN13: 9781478783701
• Langue: English

Extrait

The opinions expressed in this manuscript are solely the opinions of the author and do not represent the opinions or thoughts of the publisher. The author has represented and warranted full ownership and/or legal right to publish all the materials in this book.

Alert Medical Series: USMLE Alert II
All Rights Reserved.
Copyright © 2016 Ala Sarraj, MD
v6.0 r1.0

Cover Photo © 2016 thinkstockphotos.com. All rights reserved - used with permission.

This book may not be reproduced, transmitted, or stored in whole or in part by any means, including graphic, electronic, or mechanical without the express written consent of the publisher except in the case of brief quotations embodied in critical articles and reviews.

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ISBN: 978-1-4787-8370-1

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PRINTED IN THE UNITED STATES OF AMERICA

Preface
Alert M edical Series is a compilation of powerful random high yield notes and comparisons that will guarantee comprehensive and effective knowledge base and high score passing rates in the fields of USMLE (US Medical Licensing Exam), INTERNAL MEDICINE and EMERGENCY MEDICINE boards alike.
It reflects years of revision and update that will save medical students, residents and physicians measurable time of test prep and knowledge acquisition.
Alert Medical Series will serve you like multitude of pixels creating very high resolution and sharp picture.
The USMLE series notes (basic and clinical) were put in a random manner mixing basic and clinical notes to simulate real life knowledge building and to reflect the future trend in USMLE testing to combine clinical science and the clinically based basic science.
• Aphasia:
Frontal: expressive (Broca’s).
Temporal: receptive (Wernicke’s).
• Parietal lobe masses:
Dominant: miscalculation and missing right from left.
Non dominant: neglect syndrome and illness denial.
• Parietal masses: ipsilateral findings.
• Seizures are only supratentorial.
• In acute oliguric renal failure: dilated tubules and interstitial edema.
• In malignant hypertension: onion skin lesions of small vessels with fibrosis.
• Hydronephrosis can result from partial obstruction of the ureter.
Whereas complete obstruction leads to renal atrophy.
• Urinary Metanephrine levels : most accurate means to diagnose pheochromocytoma.
• Pituitary irradiation is indicated along with surgery on adrenal glands in Cushing’s to reduce the incidence Nelson’s syndrome.
• ACTH: circadian rhythm with nocturnal rise.
• Thyroid nodule workup:
Radioiodine I 123:
1. cold :
a- Cystic: aspirate, T4 suppression.
b- Solid: surgery.
2. Hot, check TFTs:
a-Hyperthyroid: radioactive Iodine.
b-Euthyroid : observe.
• Thyroid cancer:
Papillary: lobectomy.
Follicular: total resection incl. lymph nodes.
Medullary: total thyroidectomy.
Anaplastic: total resection with modified neck dissection.
• Aldosterone suppresses Renin production
Renin leads to increased aldosterone.
• Prostate cancers don’t metastasize intracranially.
• Intracranial pressure increases with age.
• Increased ICP: headache, vomiting, papilledema.
• Dexamethasone suppression test: no response in adrenal adenoma or carcinoma.
• Tonsillar he rniation: increased ICP due to obstruction of ventricular flow.
• Corticosteroids are effective in reducing peri tumor and peri abscess edema in the brain.
• CT scan is of choice for all suspected cases of increased ICP.
• Brain tumors: most common malignancy during childhood.
• Benign gliomas are commonly cystic, spread is along white matter bundles.
• Ependymoma: CSF seeding.
• Colloid cyst (3 rd ventricle): positional hydrocephalus, ie: headache and vomiting on tilting head forward.
• Meningioma:
Most common benign intracranial tumor.
Parasagittal.
Blood supply by external carotid artery.
• Prolactin producing microadenomas: most common pituitary tumors.
• Pineal tumors:
Benign and resectable: teratoma.
Malignant and radiosensitive: germinoma.
Malignant and radio-resistant: pinealoblastoma, malignant teratoma.
• Acoustic neuroma is a schwannoma.
• Metastatic tumors in the brain: usually locate at the grey white junction.
• Subarachnoid hemorrhage: trauma is the most common cause.
• Saccular (berry) aneurysm: 80% anterior.
• Uncal hernia leads to obstruction of posterior cerebral artery.
• Arteriovenous malformation (AVM): most common cause of spontaneous subarachnoid hemorrhage in childhood.
• Epidural tumor: mostly metastatic.
• The majority of herniated discs respond to bed rest alone.
• In hydrocephalus: “ sunset eyes “ sign is due to ventricular pressure on the quadrageminal plate.
• Hyperpa rathyroidism leads to formation of triple phosphate calculus.
• Prolonged immobility leads to formation of calcium stones.
• Urgency is due to vesical outlet inflammation as in cystitis, urethritis and prostitis.
• Cystine stones: radiopaque.
• Classic triad of renal tumors:
Mass, pain and hematuria.
• Hydronephrosis: ultrasound for diagnosis, and pyeloplasty is the intervention of choice.
• Cryptorchidism: orchiopexy is preferred after 6 weeks.
• Exstrophy: reconstruction within the first 24 hrs of life.
• Long thoracic nerve injury: leads to winged scapula.
• Pyogenic arthritis: most commonly due to staph.
• Torticollis (wryneck) of newb orn: due to muscular venous infarction in uterus.
• Pancreatitis may also lead to splenic vein thrombosis with subsequent gastric varices and bleeding.
• Inflammatory bowel disease is associated with erythema nodosum or pyoderma gangrenosum.
• Resolution of the diarrhea after an empiric trial of enzyme supplementation is confirmatory for pancreatic insufficiency.
• Half of patients with inflammatory bowel disease have osteopenia , with an increased risk of osteoporosis and fracture.
• The most commonly affected sites of colonic ischemia are the descending, sigmoid, and splenic flexure.
Colonoscopy is the primary diagnostic procedure.
• Primary biliary cirrhosis:
Affects women > men and is associated with an elevated antimitochondrial antibody titer.
Ursodeoxycholic acid therapy may affect long-term outcome.
• Primary sclerosing cholangitis can be identified radiographically by the classic beads-on-a-string appearance of the bile ducts.
• There is no chronic state of hepatitis A infection.
• Nursemaid elbow: radial head subluxation.
• Hyperparathyroidism causes increased urinary hydroxyproline.
• Warthin’s tumor occurs only in the parotids.
• Psammoma bodies: thyroid papillary tumor.
Hurhtle cells : thyroid follicular tumor.
• Laryngeal cancers: mostly in glottic and supraglottic folds.
• Maxillary fractures:
LeForte 1: Transverse.
LeForte 2: Pyramidal.
LeForte 3: Craniofacial.
• Megaloblastic anemia (folic acid deficiency):
Alcohol.
Nontropical sprue.
Thalassemia, sickle cell disease.
Pregnancy.
• Aldosterone increases the acidity of the urine.
• A concentrated urine devoid of sodium : can be encountered in congestive heart failure.
• Acid phosphatase: exists in liver, kidney, bone and erythrocytes.
• Prostate:
1. Inner: estrogen dependent.
2. Outer: androgen dependent.
• Lymphocytic stroma is characteristic of seminoma.
• Leydig cell tumor leads to steroid production.
• Germ cell tumor leads to polypeptide production.
• Borderline tumors of the ovary : no stromal invasion but may have spread beyond the ovary at diagnosis.
• Breast fibroadenoma: well circumscribed but not encapsulated.
• The distinguishing factor between atrophic and superficial gastritis: the presence or absence of parietal cells respectively.
• Gastric hyperplastic polyps: non malignant potential.
• Cholera: no mucosal denudation.
• Typhoid ulcerations: longitudinal.
• Acute gastric ulcers are usually painless (burns…).
• Pathologic diagnosis of appendicitis is best confirmed with the presence of polymorphs in the muscular layer.
• Splenic flexure is the most common site for ischemic colitis.
•