Bare Minimum Keyword Associations USMLE & COMLEX Review Northwestern Medical Review [email protected] Northwestern Medical Review PO Box 22174 Lansing, Michigan 48909 www.northwesternmedicalreview.com Copyright © 2015 Northwestern Medical Review eBookit.com and Northwestern Medical Review Second Edition ISBN 978-0-9960-9340-1 All rights reserved. Written, published, and printed in the United States of America. No part of this book may be used, reproduced, or transmitted in any form or by any means, electronic or mechanical without written permission from its author or Northwestern Medical Review. All photos adapted from fotolia.com Northwestern Medical Review claims no rights to USMLE or COMLEX USMLE ® National Board of Medical Examiners COMLEX ® National Board of Osteopathic Medical Examiners This book is adapted from the first chapter of Primary Care for the USMLE and COMLEX by Northwestern Medical Review. The full book version is primarily intended to accompany online or live review courses from Northwestern Medical Review. How to use this book This book is adapted from the first chapter of Northwestern Medical Review’s Primary Care for the USMLE and COMLEX book. It contains exceptionally high-yield material found on board exams. The mini-chapters are divided into sections containing commonly tested concepts with keywords that should immediately come to mind while you’re taking your exam. In the back of the book are two additional sections: a Test Your Knowledge section containing questions and answers with explanations from our follow-along lecture workbooks and NMR Question Bank, and a Sample Mnemonics section containing examples of memorable mnemonics from our course material. A note from the author This book is yours. It is your companion for the boards. Until your exam is over, you would be smart to have it handy – in your backpack, in your jacket, or in your pocket. You can read it anywhere – on a bus, on a train, on a plane, or even in the rain. This book has no beginning and no end. Each part is both dependent on and independent of the other parts. Much like the human body. You can start it anywhere – at the beginning, in the middle, or at the end. You can open it anytime – early morning, midday, or at night. You may write on it, draw on it, and add to it – and you may do so as your heart desires. It will tell you how much you have learned and what you have yet to learn. The more you read it, wear it, and tear it, the more you will earn from it. And when it’s all over, you will remember that you had one companion the whole way – the one that was there for you every day. Dr. Jahan Eftekar Table of Contents 1. Cardiology 1 2. Vasculitides 6 3. Hematology 10 4. Hematopoietic and Lymphatic System 13 5. Pulmonology 16 6. Gastroenterology 21 7. Liver and Pancreas 26 8. Nephrology 31 9. Male Reproductive 35 10. Female Reproductive 37 11. Integumentary System 41 12. Endocrinology 44 13. Musculoskeletal System 50 14. Central Nervous System 53 15. Autoimmune Diseases 58 16. Immune Deficiencies 62 17. Oncology 64 18. Genetics 68 19. Infectious Diseases 73 20. Cellular Pathology 76 21. Behavioral Sciences 79 22. Nutritional Deficiencies 80 Test Your Knowledge 82 Answers 87 Sample Mnemonics 91 Contact Us! 93 Northwestern Medical Review 1 Bare Minimum Keyword Associations 1 CARDIOLOGY Rheumatic Fever ⋅ Group A β-hemolytic Streptococcus ⋅ Pancarditis ⋅ Aschoff bodies ⋅ Valve verrucae ⋅ Chorda tendineae thickening and fusion ⋅ Sydenham’s chorea ⋅ MacCallam’s plaque (Left Atrium) ⋅ Migratory Polyarthritis ⋅ Erythema marginatum ⋅ Elevated ASO ⋅ Fish Mouth (buttonhole deformity) Coarctation Of Aorta ⋅ Around or on ductus arteriosus site ⋅ Turner’s Syndrome ⋅ Dilatation of intercostal arteries ⋅ Hypertension—upper extremities ⋅ Left ventricular hypertrophy ⋅ Distal Aortic Arch ⋅ Elevated renin / angiotensin 2 Northwestern Medical Review Tricuspid Valve Endocarditis ⋅ IV Drug Use ⋅ Young men without predisposing cardiac lesion Non-Bacterial Endocarditis (Marantic) ⋅ Systemic malignancy ⋅ Valve Surfaces Non-septic peripheral emboli ⋅ Libman-Sachs Endocarditis ⋅ Systemic Lupus Erythematosus ⋅ Mitral and tricuspid valves ⋅ Fibrinoid necrosis Cor Pulmonale ⋅ Right ventricular dilatation ⋅ Severe Lung disease with pulmonary hypertension ⋅ Elevated CK-MB ⋅ LDH flipped fraction I > 2 ⋅ Abdominal aortic aneurysm ⋅ Hypertrophy of muscular pulmonary arteries Atrial Myxoma ⋅ Left atrium ⋅ Mitral ⋅ Ball-valve obstruction Mitral Prolapse ⋅ Young exercising thin women ⋅ Systolic prolapse of mitral into the left atrium 3 Bare Minimum Keyword Associations ⋅ Most frequent valvular lesion ⋅ Marfan’s disease (rare association) ⋅ Parachute deformity ⋅ Arrhythmias ⋅ Mid-systolic click, late systolic murmur, and mitral regurgitation Carcinoid Syndrome ⋅ Cutaneous flushing ⋅ Asthmatic wheezing ⋅ Endocardial Plaque often on the right side ⋅ High level of serotonin (5 HT) ⋅ Recurrent diarrhea Myocardial Infarction ⋅ ST elevation ⋅ Crushing chest pain at rest ⋅ Troponin I and CPK Early AST later; and LDH latest ⋅ LDH 1 > LDH 2 ⋅ More in men than women ⋅ Most common cause of cardiac death less than 1 hour after MI is ventricular tachycardia. Heart Failure ⋅ Left-sided; Pulmonary edema ⋅ Right-sided; Hepatomegaly, Nutmeg liver Rubella ⋅ Patent Ductus Arteriosus ⋅ IgM antibody (anti-rubella) indicates recent primary infection 4 Northwestern Medical Review ⋅ Congenital associated with deafness, cataracts, glaucoma, and mental retardation ⋅ Prenatal worse than postnatal Cardiomyopathies ⋅ Hypertrophic: autosomal dominance, obstructive. A.K.A. Idiopathic hypertrophic sub-aortic stenosis ⋅ Dilated: Congestive. Associated with ethanol, doxorubicin (adriamycin), mercury and lead poisoning, thyrotoxicosis, hypophosphatemia, hypocalcemia, thiamine deficiency. Left and right congestive failure. ⋅ Restrictive: Impaired diastolic filling. Sarcoidosis, amyloidosis, and carcinoid syndrome ECG Readings and Associated Conditions Hypercalcemia ⇔ Short QT Hypocalcemia ⇔ Long QT Hypokalemia ⇔ Flat T and U waves Hyperkalemia ⇔ Tall T, wide QRS Digitalis ⇔ Long PR, Short QT First Degree AV Block ⇔ Long PR > 0.2 Second Degree AV ⇔ Gradual PR increase Block (Mobitz I) until missing a QRS Second Degree AV ⇔ Constant PR Block (Mobitz II) Third Degree AV Block ⇔ Independent P and QRS (Complete) Premature Ventricular ⇔ Wide, tall, odd QRS Contraction Atrial Flutter ⇔ Saw-toothed pattern 5 Bare Minimum Keyword Associations ECG Readings and Associated Conditions Atrial Fibrillation ⇔ Irregularly spaced QRS, no detectable P wave Ventricular Tachycardia ⇔ Rapid, odd QRS Left Atrial Hypertrophy ⇔ M-Shaped P wave Right Atrial ⇔ Tall and wide P Hypertrophy Left Ventricular ⇔ Tall and wide QRS Hypertrophy 6 Northwestern Medical Review 2 VASCULITIDES Atherosclerosis ⋅ Mural thrombus ⋅ Men more than women ⋅ Hypercholesterolemia ⋅ Abdominal aorta, coronary artery and carotid artery ⋅ Inverse relation to HDL cholesterol Pulmonary Embolism ⋅ Wasted ventilation in the affected, and over- perfusion of the remaining lung tissue ⋅ Wedge-shaped infarcts ⋅ Immobilized post-op patients ⋅ Deep venous thrombosis ⋅ Lower extremity Syphilitic Aortic Aneurysm ⋅ Ascending aorta ⋅ Tree bark appearance ⋅ Tertiary syphilis ⋅ Aortic valve insufficiency 7 Bare Minimum Keyword Associations Aortic Dissecting Aneurysm ⋅ Cystic medial necrosis ⋅ Longitudinal intraluminal tear ⋅ Ascending aorta ⋅ Marfan’s Syndrome ⋅ Hypertension and Hemopericardium Idiopathic Hypertrophic Subaortic Stenosis ⋅ Haphazard Myocardial Arrangement ⋅ Ca++ channel blockers Wegener’s Granulomatosis ⋅ Paranasal sinuses ⋅ Otitis media ⋅ Necrotizing arteritis and glomerulonephritis ⋅ Granuloma formation ⋅ C-ANCA ⋅ TRT: Methotrexate Malignant Hypertension ⋅ Young male African Americans ⋅ Accelerated, early death ⋅ Flea-bitten Kidney Berry Aneurysm ⋅ Circle of Willis ⋅ Bifurcation of cerebral arteries ⋅ Subarachnoidal hemorrhage 8 Northwestern Medical Review Secondary Hypertension ⋅ Renal ischemia, stenosis ⋅ Coarctation of aorta ⋅ Pheochromocytoma ⋅ Hyperthyroidism ⋅ Cushing’s syndrome ⋅ Primary aldosteronism Thromboangiitis Obliterans ⋅ Buerger’s disease ⋅ Young Jewish men ⋅ Heavy smoking ⋅ Ischemia of extremities Polyarteritis Nodosa ⋅ P-ANCA ⋅ Small-medium sized arteries ⋅ Increased ESR Budd-Chiari Syndrome ⋅ Occlusion of inferior vena cava ⋅ Central lobular hepatic necrosis ⋅ Congestive liver disease ⋅ Polycythemia vera 9 Bare Minimum Keyword Associations Vasoactive Agents Vasoconstriction Thromboxane A2 (TXA2) Leukotrienes: LTC4, LTD4, and LTE4 Platelet activating factor (RAF) Vasodilation Endothelial Prostacyclin PGI2 PGD2, PGE2, PGF2? Bradykinin RAF EDRF (endothelial derived relaxing factor) = NO (nitric oxide) Increasing Vascular Permeability Serotonin Histamine Bradykinin PGD2, PGE2, PGF2? LTC4, LTE4, LTD4 Vasoconstriction 10 Northwestern Medical Review 3 HEMATOLOGY Hereditary Spherocytosis ⋅ Spectrin defect ⋅ Increased RBC Brittleness ⋅ Increased mean corpuscular hemoglobin concentration G6PD Deficiency ⋅ Antimalarial induced hemolysis ⋅ X-linked ⋅ Episodic and acute ⋅ Mediterranean heritage + African American ⋅ Sulfa drugs induced hemolysis ⋅ Fava beans ⋅ Intravascular hemolysis Pyruvate Kinase Deficiency ⋅ Autosomal recessive ⋅ Chronic anemia, non-episodic ⋅ Non-spherocytic hemolytic anemia Sickle Cell Anemia ⋅ Substitution of VAL for glutamic acid ⋅ African Americans 11 Bare Minimum Keyword Associations ⋅ Resistance to malaria ⋅ Small spleen in adults ⋅ Pigment gallstones ⋅ Chronic leg ulcers ⋅ Painful occlusion