Revision notes for USMLE and other medical exams are always needed for the preparation at the time of the exam They are useful for the NMCLE exam, USMLE exam, AIIMS exam, PMDC exam, and PLAB exam, These are collected from different sources also found in First Aid 2020. These one-liners will help with your medical entrance exams. usmle step 1 score and so on.
One-liner revision notes for a USMLE and medical exams
1. Acromegaly 9 6 Diagnosis: OGTT followed by GH conc.
2. Cushing’s Diagnosis: 24hr urinary free cortisol. Addison’s –> short synacthen.
3. Rash on buttocks –> Dermatitis herpetiformis (coeliac dx).
4. AF with TIA –> Warfarin. Just TIA’s with no AF –> Aspirin
5. Herpes encephalitis –> temporal lobe calcification OR temporoparietal attenuation 9 6
subacute onset i.e. Several days.
6. Obese woman, papilloedema/headache –> Benign Intracranial hypertension.
7. Drug-induced pneumonitis –> methotrexate or amiodarone.
8. chest discomfort and dysphagia –> achalasia.
9. foreign travel, macpap rash/flu-like illness –> HIV acute.
10. cause of gout –> dec urinary excretion.
11. bullae on hands and fragile SKIN torn by minor trauma –> porphyria cutanea tarda.
12. Splenectomy –> need pneumococcal vaccine AT LEAST 2 weeks pre-op and for life.
13. primary hrperparathyroidism –> high Ca, normal/low PO4, normal/high PTH (in elderly).
14. middle-aged man with KNEE arthritis –> gonococcal sepsis (older people -> Staph).
15. sarcoidosis, erythema nodosum, arthropathy –> Loffgrens syndrome benign, no Rx needed.
16. TREMOR postural, slow progression, titubation, relieved by OH->benign essential TREMOR AutDom. (MS titbation, PD 9 6 no titubation)
17. electrolytes disturbance confusing 9 6 low/high Na.
18. contraindications lung Surgery –> FEV dec bp 130/90, Ace inhibitors (if proteinuria analgesic induced headache.
21. 1.5 cm difference between kidneys -> Renal artery stenosis –> Magnetic resonance angiogram.
22. temporal tenderness–> temporal arteritis -> steroids > 90% ischaemic neuropathy, 10% retinal art occlusion.
23. severe retroorbital, daily headache, lacrimation –> cluster headache.
24. pemphigus involves mouth (mucus membranes), pemphigoid 9 6 less serious NOT mucosa.
25. diagnosis of polyuria -> water deprivation test, then DDAVP.
26. insulinoma -> 24 hr supervised fasting hypoglycemia.
27. Diabetes Random >7 or if >6 OGTT (75g) -> >11.1 also seen in HCT.
28. causes of villous atrophy: coeliac (lymphocytic infiltrate), Whipples, dec Ig, lymphoma, trop sprue (rx tetracycline).
29. diarrhea, bronchospasm, flushing, tricuspid stenosis -> gut carcinoid c liver mets.
30. hepatitis B with general deterioration -> hepatocellular carcinoma.
31. albumin normal, total protein high -> myeloma (hypercalcemia, electrophoresis).
32. HBsAg positive, HB DNA not detectable –> chronic carrier.
33. Inf MI, artery involved -> Right coronary artery.
34. Aut dom conditions: Achondroplasia, Ehler Danlos, FAP, FAMILIAL hyperchol,Gilberts,
Huntington’s, Marfans’s, NFT I/II, Most porphyrias, tuberous sclerosis, vWD, PeutzJeghers.
35. X linked: Beck/Duch musc dyst, alports, Fragile X, G6PD, Haemophilia A/B.
36. Loud S1: MS, hyperdynamic, short PR. Soft S1: immobile MS, MR.
37. Loud S2: hypertension, AS. Fixed split: ASD. Opening snap: MOBILE MS, severe near S2.
38. HOCM/MVP – inc by standing, dec by squatting (inc all others). HOCM inc by Valsalva, decks all others. Sudden death athlete, FH, Rx. Amiodarone, ICD.
39. MVP suddenly worsened post-MI. Harsh systolic murmur radites to axilla.
40. Dilated Cardiomyopathy: OH, bp, thiamine/selenium deficiency, MD, coxsackie/HIV,
preg, doxorubicin, infiltration (HCT, sarcoid), tachycardia.
41. Restrictive Cardiomyopathy: scleroderma, amyloid, sarcoid, HCT, glycogen storage, Gauchers, fibrosis, hypereosinophilia Lofflers, carcinoid, malignancy, radiotherapy, toxins.
42. Tumor compressing Respiratory tract –> investigation: flow volume loop.
43. Guillan Barre syndrome: check VITAL CAPACITY.
44. Horners sweating lost in the upper face only, lesions proximal to the common carotid artery.
45. Internuclear ophthalmoplegia: medial longitudinal fasciculus connects CN nucleus 3-4. Ipsilateral adduction palsy, contralateral nystagmus. Aide Memoire (TRIES TO YANK THE ipsilateral BAD eye ACROSS THE nose ). Convergence retraction nystagmus, but
convergence reflex is normal. Causes: MS, SLE, Miller Fisher, overdose(barb, phenytoin, TCA), Wernicke.
46. Progressive Supranuclear palsy: Steel Richardson. Absent voluntary downward gaze, normal doll’s eye. i.e. Occulomotor nuclei intact, supranuclear Pathology.
47. Perinauds syndrome: dorsal midbrain syndrome, damaged midbrain and superior
colliculus: impaired upgaze (cf PSNP), lid retraction, convergence preserved. Causes: pineal
tumor, stroke, hydrocephalus, MS.
48. dementia, gait abnormality, urinary incontinence. Absent papilloedema–>Normal pressure hydrocephalus.
49. Acute red eye -> acute closed-angle glaucoma >> less common (and uveitis, scleritis, episcleritis, subconjunctival hemorrhage).
50. wheels, URTICARIA, drug-induced -> aspirin.
51. sweats and weight gain -> insulinoma.
52. diagnostic test for asthma -> morning dip in PEFR >20%.
53. Causes of SIADH: chest/cerebral/pancreas Pathology, porphyria, malignancy, Drugs (carbamazepine, chlorpropamide, clofibrate, antipsychotics, NSAIDs, rifampicin, opiates)
54. Causes of Diabetes Insipidus: Cranial: tumor, infiltration, trauma Nephrogenic: Lithium, amphotericin, demeclocycline, prolonged hypercalcemia/hyponatremia, FAMILIAL X
linked type
55. Bisphosphonates: inhibit osteoclast activity, and prevent steroid-induced osteoporosis (vitamin D also).
56. Return from airline flight, TIA-> paradoxical embolus do TOE.
57. alcoholic, given glucose develops nystagmus -> B1 deficiency (Wernicke). Confabulation-> Korsakoff.
58. mono-artropathy with thiazide -> gout (neg birefringence). NO ALLOPURINOL for acute.
59. painful 3rd nerve palsy -> posterior communicating artery aneurysm till proven otherwise
60 late complication of scleroderma –> pulmonary hypertension plus/minus fibrosis.
61. causes of erythema mutliforme: lamotrigine
62. vomiting, abdominal pain, hypothyroidism -> Addisonian crisis (TFT typically abnormal in this setting DO NOT give thyroxine).
63. mouth/genital ulcers and oligoarthritis -> behcets (also eye /SKIN lesions, DVT)
64. mixed drug overdose most important step -> N-acetylcysteine (time-dependent prognosis)
65. cavernous sinus syndrome – 3rd nerve palsy, proptosis, periorbital swelling, conj injection
66. asymmetric parkinsons -> likely to be idiopathic
67. Obese, NIDDM female with abnormal LFTs -> NASH (non-alcoholic steatotic hepatitis)
68. fluctuating level of consciousness in elderly plus/minus deterioration –> chronic subdural. Can last even longer than 6 months
69. Sensitivity –> TP/(TP plus FN) e.g. For SLE – ANA highly sens, dsDNA: highly specific
70. RR is 8%. NNT is —-> 100/8 –> 50/4 –> 25/2 –> 13.5
71. ipsilateral ataxia, Horners, contralateral loss pain/temp –> PICA stroke (lateral medullary syndrome of Wallenberg)
72. renal stones (80% calcium, 10% uric acid, 5% ammonium (proteus), 3% other). Uric acid and cysteine stones are radiolucent.
73. hyperprolactinemia (galactorrhea, amenorrhea, low FSH/LH) -> Da antigens
(metoclopramide, chlorpromazine, cimetidine NOT TCA’s), pregnancy, PCOS, pit tumor/microadenoma, stress.
74. Distal, asymmetric arthropathy -> PSORIASIS
75. episodic headache with tachycardia -> phaeochromocytoma
76. Very raised WCC -> ALWAYS think of leukemia.
77. Diagnosis of CLL –> immunophenotyping NOT cytogenetics, NOT bone marrow
78. Prognostic factors for AML -> bm karyotype (good/poor/standard) >> WCC at diagnosis.
79. Pancytopenia with raised MCV –> check B12/folate first (other causes possible, but do this FIRST). Often associated with phenytoin use –> decreased folate
80. miscarriage, DVT, stroke –> LUPUS anticoagulant –> lifelong anticoagulation
81. Hb elevated, dec ESR -> polycythemia (2ndry if paO2 low)
82. anosmia, delayed puberty -> Kallman’s syndrome (hypogonadotropic hypogonadism)
83. diag of PKD -> renal US even if think anorexia nervosa
85. commonest finding in G6PD hemolysis -> hemoglobinuria
86. mitral stenosis: loud S1 (soft s1 if severe), opening snap. Immobile valve -> no snap.
87. Flank pain, urinalysis: blood, protein -> renal vein thrombosis. Causes: nephrotic syndrome, RCC, amyloid, acute pyelonephritis, SLE (antiphospholipid syndrome which is
recurrent thrombosis, fetal loss, dec plt. Usual cause of CNS manifestations associated with LUPUS anticoagulant, anticardiolipin ab)
88. Anemia in the elderly assumes GI malignancy
89. hypothermia, acute renal failure -> rhabdomyolysis (collapse assumed)
90. pain, numbness lateral upper thigh –> meralgia paraesthesia (lat cutaneous nerve
compression usually by by ing ligament)
91. diagnosis of hemochromatosis: screen with Ferritin, confirm by tranferrin saturation, genotyping. If nondiagnostic do a liver biopsy 0.3% mortality
92. 40 mg hydrocortisone divided doses (bd) –> 10 mg prednisolone (ie. Prednisolone is x4 stronger)
93. BTS: TB guidelines 9 6 close contacts -> Heaf test -> positive CXR, negative –> repeat Heaf in 6 weeks. Isolation is not required.
94. Diptheria -> exudative pharyngitis, lymphadenopathy, cardio, and neurotoxicity.
95. Indurated plaques on cheeks, scarring alopecia, hyperkeratosis over hair follicles ->>Discoid LUPUS
96. Weight loss, malabsorption, inc ALP -> pancreatic cancer
97. foreign travel, tender RUQ, raised ALP –> liver abscess do U/S
98. Weight loss, anemia (macro/micro), no obvious cause -> coeliac (diarrhea does NOT have to be present)
99. haematuria, proteinuria, best investigation –> if glomerulonephritis suspected –> renal
biopsy
100. venous ulcer treatment –> exclude arteriopathy (eg ABPI), control edema, prevent infection, compression bandaging.
101. Malaria, incubation within 3/12. can be relapsing /remitting. Vivax and Ovale (West
Africa) longer incubation.
102. Fever, lymphadenopathy, lymphocytosis, pharyngitis —>EBV —> heterophile antibodies
103. GI bleed after endovascular AAA Surgery –> aorto-enteric fistula
104. The young girl suspects Anorexia Nervosa 9 6 linugo hair, functional hypogonadotropic hypogonadism -> amenorrhea. LH and FSH are both low. All other hormones are usually normal. Ferritin low.
105. Reiters Syndrome arthritis, uveitis, urethritis 9 6 Chlymidia, campylobacter, Yersinia,
SALMONELLA , Shigella. Balanisits.
106. PKD 9 6 aut dom Chr 16/4 assoc berry aneurysm, mitral/aortic regurg
107. Porphyria 9 6 photosensitivity, blisters, scars with Millia, hypertrichosis
108. heart sounds: Aortic Stenosis s2 paradoxical split, length proportional to the severity
109. Vitiligo –commonest associations pernicious anemia >>> type 1 DM, autoimmune addisons, autoimmune thyroid dx
110. Gout — blood urate high/low/normal, joint aspirate pos birif, ppt thiazides, NO allopurinol/aspirin in acute phase
111. Peripheral neuropathy
- B12 rapid, dorsal columns (joint pos, vibration), sensory ataxia, pseudoarthrosis of upper limbs
- diabetic slow, spinothalamic (pain, temp?)
- alcohol slow progressive, spinothalamic
- Pb 9 6 motor upper limbs
112. CNS abnormalities in HIV: toxoplasmosis (ring enhancing), lymphoma (solitary lesion). HIV encephalopathy, progressive multifocal leukoencephalopathy (PML demyelination in advanced HIV, low attenuation lesions)
113. Travelers diarrhea: chronic (>2 WEEKS) giardia (insidious onset rx. Metronidazole), SALMONELLA (serious systemic illness), E.coli (rx. Ciprofloxacin), Shigella
114. Renal syndrome 9 6 minimal change disease, membranous, IgA nephropathy, post-streptococcal.
115. If you see blood on urinalysis forget about RAS
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