Passing the USMLE : clinical knowledge

1 Internal Medicine........................................................................................... 1 Endocrinology ............................................................................................... 3 Pituitary Gland......................................................................................... 3 Thyroid Gland.......................................................................................... 4 Parathyroid Gland.................................................................................... 6 Adrenal Gland.......................................................................................... 7 Pancreas ................................................................................................... 8 Diabetes Mellitus (DM)............................................................................ 8 Others ....................................................................................................... 10 Drug Induced Endocrinal Disorders......................................................... 10 Endocrinal Causes of Excessive Sweating................................................. 10 Gastrointestinal System................................................................................. 10 Musculature and Nerve Supply ................................................................ 10 Digestion .................................................................................................. 10 Hormones and Mediators......................................................................... 10 Secretions ................................................................................................. 11 Dysphagia................................................................................................. 11 Esophageal Varices................................................................................... 12 Achalasia .................................................................................................. 12 Diffuse Esophageal Spasm ....................................................................... 12 Plummer Vinson Syndrome...................................................................... 12 Peptic Ulcer Disease (PUD) ..................................................................... 12 Celiac Sprue.............................................................................................. 13 Inflammatory Bowel Disease IBD............................................................ 13 Irritable Bowel Syndrome (IBS) ............................................................... 13 Diarrhea ................................................................................................... 14 Colon Cancer............................................................................................ 15 Familial Adenomatous Polyposis (FAP) .................................................. 15 Diverticular Disease ................................................................................. 16 Acute Pancreatitis..................................................................................... 16 Chronic Pancreatitis ................................................................................. 16 Pancreatic Cancer ..................................................................................... 16 Hepatology .................................................................................................... 17 Introduction ............................................................................................. 17 Hepatitis ................................................................................................... 17 Liver Cirrhosis.......................................................................................... 18 Hepatic Encephalopathy .......................................................................... 19 Spontaneous Bacterial Peritonitis (SBP)................................................... 20 Biliary Cirrhosis........................................................................................ 20 Hepatocellular Carcinoma (Hepatoma).................................................... 20 Jaundice.................................................................................................... 20 ix Congenital Hyperbilirubinemia .................................................................. 20 Drug Induced Hepatotoxicity..................................................................... 21 Hematology ..................................................................................................... 21 Red Blood Cells (RBCs) ............................................................................. 21 White Blood Cells (WBCs) ......................................................................... 21 Platelets ...................................................................................................... 22 Coagulation Cascade.................................................................................. 23 Iron Deficiency Anemia.............................................................................. 23 Megaloblastic Anemia ................................................................................ 24 Hemolytic Anemia...................................................................................... 24 Aplastic Anemia ......................................................................................... 24 Hypersplenism............................................................................................ 24 Thalassemia ................................................................................................ 25 Sickle Cell Disease ...................................................................................... 25 Spherocytosis.............................................................................................. 26 G6PD Deficiency........................................................................................ 26 Paroxysmal Nocturnal Hemoglobinuria (PNH) ......................................... 26 Hemophilia ................................................................................................. 27 Idiopathic Thrombocytopenic Purpura (ITP)............................................. 27 Von Willebrand Disease (VWD) ................................................................ 27 Disseminated Intravascular Coagulopathy (DIC) ...................................... 27 Antiphospholipid Antibody Syndrome............................................................ 27 Thrombotic Thrombocytopenic Purpura (TTP)......................................... 27 Myeloproliferative Disorders...................................................................... 28 Henoch Schonlein Purpura......................................................................... 28 Multiple Myeloma...................................................................................... 29 Leukemia.................................................................................................... 29 Lymphoma ................................................................................................. 30 Common Blood Transfusion Reactions...................................................... 31 Renal System ................................................................................................... 31 Introduction ............................................................................................... 31 Fluid Measurements ................................................................................... 31 Acid-base Balance ...................................................................................... 31 Electrolytes ................................................................................................. 32 Nephrotic Syndrome .................................................................................. 32 Nephritic Syndrome ................................................................................... 33 Urinary Tract Infection (UTI).................................................................... 33 Interstitial Nephritis ................................................................................... 34 Polycystic Kidney Disease (PKD) .............................................................. 34 Acute Renal Failure ................................................................................... 34 Chronic Kidney Disease (CKD) ................................................................. 34 Nephro- and Uretero-Lithiasis ................................................................... 35 Renal Tubular Acidosis (RTA) .................................................................. 35 Renal Artery Stenosis (RAS) ...................................................................... 35 Urinary Incontinence.................................................................................. 36 Neurogenic Bladder.................................................................................... 36 Drug-Induced Nephropathy ....................................................................... 36 Nephrology Notes ...................................................................................... 36 Rheumatology ................................................................................................. 37 Rheumatoid Arthritis ................................................................................. 37 Osteoarthritis.............................................................................................. 38 Systemic Lupus Erythematosus (SLE)........................................................ 38 Polyarteritis Nodosa (P.A.N.) .................................................................... 39 Ankylosing Spondylitis............................................................................... 39 Reiter’s Syndrome ...................................................................................... 39 x Contents Temporal Arteritis ........................................................................................ 39 Wegener Granulomatosis ........................................................................ 40 Takayasau Disease .................................................................................. 40 Behcet Syndrome..................................................................................... 40 Dermatomyositis ..................................................................................... 40 Gout and Pseudogout.............................................................................. 40 Scleroderma............................................................................................. 41 Polymyalgia Rheumatica ......................................................................... 41 Osteoporosis and Osteomalacia............................................................... 41 Paget’s Disease of the Bone ..................................................................... 41 Septic Arthritis ........................................................................................ 41 Fibromyalgia ........................................................................................... 42 Cardiovascular System ................................................................................. 42 Introduction ............................................................................................ 42 Electrocardiogram Waves........................................................................ 42 Action Potentials ..................................................................................... 43 Cardiac Cycle .......................................................................................... 43 Heart Sounds........................................................................................... 43 Heart Murmurs ....................................................................................... 43 Jugular Vein Waves ................................................................................. 43 Important Equations ............................................................................... 44 Hypertension ........................................................................................... 44 Congestive Heart Failure (CHF) ............................................................. 46 Atherosclerosis ........................................................................................ 48 Myocardial Infarction ............................................................................. 48 Pericarditis............................................................................................... 49 Pericardial Effusion and Tamponade ...................................................... 49 Rheumatic Fever ..................................................................................... 49 Endocarditis ............................................................................................ 49 Hypertrophic Obstructive Cardiomyopathy (HOCM) ............................ 50 Coarctation of the Aorta ......................................................................... 50 Aortic Dissection ..................................................................................... 50 Aortic Aneurysm ..................................................................................... 51 Arrhythmias ............................................................................................ 51 Shock....................................................................................................... 54 Dyslipidemia............................................................................................ 55 Neurology..................................................................................................... 55 Cerebral Cortex ....................................................................................... 55 Alzheimer’s Disease ................................................................................. 56 Glioblastoma Multiforme........................................................................ 57 Pseudotumor Cerebri............................................................................... 57 Cavernous Sinus Thrombosis .................................................................. 57 Meningitis................................................................................................ 57 Meningiomas ........................................................................................... 58 Hydrocephalus ........................................................................................ 58 Arnold-Chiari Malformation................................................................... 59 Cerebrovascular Accident (CVA) ............................................................ 59 Intracranial Hemorrhage......................................................................... 60 Concussion .............................................................................................. 61 Spina Bifida ............................................................................................. 61 Craniopharyngioma ................................................................................ 61 Cerebellar Lesions ................................................................................... 61 Hypothalamus Lesions ............................................................................ 61 Basal Ganglia Lesions ............................................................................. 62 Midbrain Lesions .................................................................................... 62 Contents xi Pontine Lesions .......................................................................................... 63 Medullary Lesions ...................................................................................... 63 Tracts and Injuries...................................................................................... 63 Spinal Cord Lesions ................................................................................... 64 Cranial Nerves............................................................................................ 65 Seizures....................................................................................................... 68 Muscular Disorders .................................................................................... 69 Disc Prolapse.............................................................................................. 69 Carpal Tunnel Syndrome ........................................................................... 69 Migraine ..................................................................................................... 70 Nerve Injuries ............................................................................................. 70 Ophthalmology........................................................................................... 71 E.N.T.......................................................................................................... 71 Important Notes and Keywords ................................................................. 71 Respiratory System.......................................................................................... 72 Important Definitions................................................................................. 72 Pulmonary Function Tests (PFTs) ............................................................. 72 Dead Space................................................................................................. 72 Respiratory Muscles ................................................................................... 72 Compliance................................................................................................. 72 Bronchio-Alveolar-Pulmonary System ....................................................... 72 Breathing and Gases................................................................................... 73 Asthma ....................................................................................................... 73 Chronic Obstructive Pulmonary Disease (COPD)...................................... 74 Respiratory Failure .................................................................................... 74 Pneumothorax ............................................................................................ 74 Lung Cancer ............................................................................................... 75 Pneumonia.................................................................................................. 76 Bronchiectasis............................................................................................. 77 Pulmonary Embolism ................................................................................. 77 Pleural Diseases .......................................................................................... 77 Interstitial Lung Disease (ILD) .................................................................. 78 Silicosis and Asbestosis............................................................................... 78 Sarcoidosis.................................................................................................. 78 Tuberculosis (TB) ....................................................................................... 79 Sleep Apnea................................................................................................ 79 Solitary Lung Nodule ................................................................................. 79 Cough......................................................................................................... 80 Drug-Induced Pulmonary Diseases ............................................................ 80 Infectious Diseases .......................................................................................... 80 Human Immunodeficiency Virus (HIV) ..................................................... 80 Rabies......................................................................................................... 81 Clostridium Tetani ..................................................................................... 81 Clostridium Difficile ................................................................................... 81 Listeria Monocytogenes ............................................................................. 82 Salmonella .................................................................................................. 82 Rickettsia.................................................................................................... 82 Bacillus Cereus ........................................................................................... 82 Cryptococcus Neoformans ......................................................................... 82 Coccidiodes Immitis ................................................................................... 83 Entamoeba Histolytica ............................................................................... 83 Giardia Lamblia ......................................................................................... 83 Plasmodium................................................................................................ 83 Miscellaneous ............................................................................................. 83 Miscellaneous .................................................................................................. 84 xii Contents 2 Dermatology ................................................................................................. 87 Skin Lesions ................................................................................................. 87 Fungal Infections.......................................................................................... 88 Tinea Capitis ........................................................................................... 88 Tinea Corporis ........................................................................................ 88 Tinea Cruris (Jock Itch)........................................................................... 88 Tinea Pedis ............................................................................................. 88 Tinea Unguium (Onychomycosis) ........................................................... 89 Tinea (Pityriasis) Versicolor .................................................................... 89 Candida Albicans .................................................................................... 89 Notes ....................................................................................................... 90 Viral Infections ............................................................................................. 90 Warts....................................................................................................... 90 Molluscum Contagiosum ........................................................................ 90 Herpes Simplex........................................................................................ 90 Herpes Zoster .......................................................................................... 91 Bacterial Infections....................................................................................... 91 Impetigo .................................................................................................. 91 Erythrasma.............................................................................................. 92 Erysipelas ................................................................................................ 92 Erysipeloid............................................................................................... 92 Necrotizing Fasciitis ................................................................................ 92 Folliculitis................................................................................................ 92 Furunculosis ............................................................................................ 92 Hidradenitis Suppurativa ........................................................................ 92 Paronychia............................................................................................... 92 Lupus Vulgaris ........................................................................................ 93 Parasitic Infections ....................................................................................... 93 Scabies ..................................................................................................... 93 Pediculosis (Lice) ..................................................................................... 93 Acne Vulgaris .......................................................................................... 93 Acne Rosacea .......................................................................................... 93 Allergic Skin Diseases................................................................................... 93 Eczema .................................................................................................... 93 Urticaria .................................................................................................. 94 Erythema Multiforme.............................................................................. 95 Erythema Nodosum ................................................................................ 95 Toxic Epidermal Necrolysis..................................................................... 96 Medication-Induced Skin Diseases .......................................................... 96 Scaly Papular Diseases ................................................................................. 96 Psoriasis................................................................................................... 96 Pityriasis Rosea ....................................................................................... 96 Lichen Planus .......................................................................................... 96 Actinic (Senile) Keratosis ........................................................................ 97 Malignant Skin Diseases............................................................................... 97 Basal Cell Carcinoma (BCC) ................................................................... 97 Squamous Cell Carcinoma (SCC)............................................................ 97 Melanoma ............................................................................................... 97 Miscellaneous ............................................................................................... 98 Vitiligo..................................................................................................... 98 Pemphigus Vulgaris ................................................................................. 98 Acanthosis Nigricans............................................................................... 99 Lipoma.................................................................................................... 99 Keloid...................................................................................................... 99 Fibrosarcoma .......................................................................................... 99 Contents xiii Desmoid Tumor ....................................................................................... 99 Dermoid Cyst ........................................................................................... 99 Sebaceous Cyst ......................................................................................... 99 3 Obstetrics ....................................................................................................... 101 Human Chorionic Gonadotrophin (HCG).................................................... 101 Human Placental Lactogen (HPL) ................................................................ 102 Feto-Placenta Unit ........................................................................................ 102 Gametogenesis............................................................................................... 102 Fertilization ................................................................................................... 103 Implantation.................................................................................................. 103 Umbilical Cord.............................................................................................. 103 Amniotic Fluid .............................................................................................. 103 Placenta ......................................................................................................... 103 Blood............................................................................................................. 104 Amniocentesis................................................................................................ 104 Diagnosis of Pregnancy ................................................................................. 105 Maternal Changes During Pregnancy............................................................ 105 Genital Tract ............................................................................................ 105 Breast Glands ........................................................................................... 105 Cardiovascular and Pulmonary Systems................................................... 105 Gastrointestinal System............................................................................ 105 Urinary System......................................................................................... 106 Endocrine System ..................................................................................... 106 Skin .......................................................................................................... 106 Metabolic Changes ................................................................................... 106 Antenatal Care .............................................................................................. 106 Assessment of Fetal Wellbeing ...................................................................... 106 Ultrasound ............................................................................................... 106 Cardiotocography (CTG)......................................................................... 107 Non Stress Test......................................................................................... 107 Intrapartum Assessment of Fetal Wellbeing............................................. 107 Abortion........................................................................................................ 107 Threatened Abortion ................................................................................ 107 Inevitable Abortion .................................................................................. 107 Septic Abortion ........................................................................................ 108 Missed Abortion....................................................................................... 108 Habitual Abortion.................................................................................... 108 Ectopic Pregnancy ......................................................................................... 108 Hydatidiform (Vesicular) Mole ..................................................................... 109 Antepartum Hemorrhage .............................................................................. 110 Vasa Previa............................................................................................... 110 Placenta Previa ......................................................................................... 110 Abruptio Placenta .................................................................................... 110 Premature Rupture of Membranes (PROM)................................................. 111 Pre-Eclampsia.......................................