HIGH YIELD REVIEW POINTS FOR REVISION BY DR ABDUL BASIT ZUBAIR Ear

1. Conductive hearing loss shows bone conduction better than air conduction (Rinne
negative) and lateralizes to the affected ear in Weber test.
2. Sensorineural hearing loss has air conduction better than bone (Rinne positive) but
Weber lateralizes to the unaffected ear.
3. Otosclerosis is a hereditary condition of abnormal bone remodeling at the stapes
footplate, often affecting young women; hearing may paradoxically improve in noisy
environments.
4. Chronic suppurative otitis media (CSOM) may cause persistent ear discharge and
hearing loss; unsafe CSOM may form cholesteatoma leading to erosion of nearby
structures.
5. Cholesteatoma is an epithelial cyst in the middle ear or mastoid with keratin debris; it
can erode ossicles and cause complications like facial palsy or brain abscess.
6. Glomus tumors are vascular tumors (paragangliomas) that can cause pulsatile tinnitus
and hearing loss; they may invade cranial nerves IX-XII.
7. Eustachian tube dysfunction leads to middle ear negative pressure and recurrent otitis
media, particularly in children due to anatomical predisposition.
8. Facial nerve injury can occur during mastoid or middle ear surgery; the tympanic
segment is especially at risk.
9. Perilymph fistula presents with sudden sensorineural hearing loss and vertigo after
trauma or straining, due to leakage of inner ear fluid.
10. Tympanometry: Type A is normal; type B (flat curve) suggests middle ear effusion; type
C suggests negative middle ear pressure.

Vertigo, Tinnitus, Otalgia

11. BPPV is caused by dislodged otoliths in semicircular canals and is diagnosed by Dix-
Hallpike maneuver, which reproduces vertigo and nystagmus.
12. Ménière’s disease involves endolymphatic hydrops, causing episodes of vertigo,
tinnitus, and sensorineural hearing loss, often with ear fullness.
13. Vestibular neuronitis is a self-limiting post-viral inflammation of the vestibular nerve
causing vertigo without hearing loss.
14. Tinnitus may be pulsatile (suggesting vascular cause like AV malformation or glomus
tumor) or non-pulsatile (sensorineural origin).
15. Otitis media can cause referred otalgia due to shared innervation with the
glossopharyngeal and vagus nerves.
 16. Ramsay Hunt syndrome (herpes zoster oticus) causes painful vesicles on ear and facial
palsy; CN VII is affected.
17. Labyrinthitis includes both vestibular and cochlear symptoms following infection; it can
follow viral URTI.
18. Superior semicircular canal dehiscence causes vertigo with loud sounds (Tullio
phenomenon); confirmed via CT.
19. Tinnitus without hearing loss might require imaging to exclude retrocochlear pathology
like acoustic neuroma.
20. TMJ dysfunction or tonsillitis can refer pain to the ear, causing otalgia with normal
otoscopic findings.

Nose

21. Nasal polyps are edematous mucosa, often bilateral and associated with asthma,
chronic rhinosinusitis, and aspirin sensitivity (Samter's triad).
22. Allergic rhinitis presents with sneezing, nasal congestion, and clear discharge; often
with allergic shiners and nasal crease.
23. Septal hematoma after nasal trauma must be drained to prevent cartilage necrosis and
resultant saddle nose deformity.
24. Woodruff’s plexus is a venous plexus on the posterior nasal floor; bleeding here is
usually profuse and difficult to control.
25. Hereditary hemorrhagic telangiectasia causes recurrent epistaxis due to fragile blood
vessels; look for mucocutaneous telangiectasias.
26. Allergic fungal sinusitis presents with thick allergic mucin and opacified sinuses with
hyperdensities on CT.
27. Rhinosporidiosis is a chronic infection caused by Rhinosporidium seeberi, presenting as
a red, friable nasal mass that bleeds on touch.
28. Unilateral nasal discharge in a child is a foreign body until proven otherwise, especially
if foul-smelling.
29. Kiesselbach’s plexus (Little’s area) is the common site for anterior epistaxis, especially
in children and dry climates.
30.Sphenopalatine artery is often the culprit in posterior epistaxis and may require
endoscopic ligation.

Throat
 31. Peritonsillar abscess presents with fever, trismus, and uvula deviation away from the
affected side; requires drainage.
32. Retropharyngeal abscess in children presents with neck stiffness, fever, and dysphagia;
may compress the airway.
33. Laryngomalacia causes inspiratory stridor in infants due to floppy supraglottic
structures; often resolves by 2 years.
34. Epiglottitis presents with high fever, drooling, and respiratory distress; "thumb sign" on
lateral neck X-ray.
35. Vocal nodules occur due to voice abuse; bilateral and symmetric on vocal cords, vs.
polyps which are unilateral.
36. Reinke’s edema is swelling of the vocal cords in smokers, causing husky voice; common
in middle-aged women.
37. Recurrent laryngeal nerve palsy causes hoarseness and a fixed vocal cord; most often
iatrogenic during thyroid surgery.
38. Arytenoid dislocation from intubation trauma causes persistent hoarseness and breathy
voice.
39. Laryngeal papillomatosis is due to HPV types 6 and 11; causes multiple vocal fold
growths and hoarseness in children.
40. Supraglottic cancers metastasize early due to rich lymphatics; glottic cancers present
early due to voice change.

Dysphagia

41. Zenker’s diverticulum is a pharyngoesophageal pouch leading to dysphagia,

regurgitation, and halitosis.
42. Plummer-Vinson syndrome occurs in iron deficiency anemia with esophageal webs and
glossitis; pre-malignant.
43. Schatzki ring causes intermittent dysphagia to solids; associated with hiatal hernia.
44.Achalasia causes failure of LES relaxation; barium swallow shows bird-beak appearance.
45. Cricopharyngeal spasm presents with intermittent globus sensation; often functional.

Neck

46. Thyroglossal cyst moves upward with tongue protrusion; common midline neck mass in
children.
 47. Branchial cleft cyst is a lateral neck mass along anterior border of SCM; arises from
incomplete obliteration of branchial clefts.
48. Reactive cervical lymphadenopathy is the most common cause of neck mass in
children; often secondary to infection.
49. Virchow’s node in the supraclavicular region may indicate gastric or abdominal
malignancy.
50. Midline neck swellings in children are usually thyroglossal duct cysts; surgical removal
requires Sistrunk procedure.

OPHTHALMOLOGY
1. Thyroid Eye Disease (Graves’ Orbitopathy)
• Presentation: Bilateral proptosis, lid retraction, restrictive extraocular movements
(inferior & medial rectus most common), NO fever/redness.
• Key Feature: Lid lag, exophthalmos, may have optic neuropathy.
• Diagnosis: Clinical + TSI antibodies (Thyroid Stimulating Immunoglobulin).
• Management: Mild → lubricants, steroids; Severe → orbital decompression.

2. Orbital vs. Preseptal Cellulitis

Feature Orbital Cellulitis Preseptal Cellulitis

 Location Post-septal (deep) Pre-septal (superficial)

Proptosis Yes No

Eye
Movement Restricted & painful Normal
s

Vision May be affected Normal

Skin infection (stye,

Cause Sinusitis (most common), trauma
bug bite)

IV antibiotics (Vancomycin + Ceftriaxone), may

Treatment Oral antibiotics
need surgery

3. Dacryocystitis (Lacrimal Sac Infection)

• Acute: Painful medial canthal swelling, pus regurgitation on pressure.

• Chronic: Constant tearing (epiphora), recurrent infections.
• Newborns: Nasolacrimal duct obstruction → Crigler massage (90% resolve by 1 year).
• Treatment:
o Acute → IV antibiotics (Augmentin). o Chronic → Dacryocystorhinostomy
(DCR).

4. Eyelid Lesions

Lesion Features Treatment

Hordeolum (Stye) Painful, lid margin, staph infection Warm compresses, drainage

Chalazion Painless, non-marginal, granuloma Steroid injection, excision

Blepharitis Crusting, itching, chronic Lid hygiene, erythromycin

5. Conjunctivitis
 Type Features Treatment

Bacterial Purulent discharge, sticky lids Fluoroquinolones (Ciprofloxacin)

Viral (Adeno) Watery discharge, preauricular LN Supportive, highly contagious

Allergic (Vernal) Itching, ropy discharge, papillae Mast cell stabilizers (Opatanol)

6. Corneal Pathology

• Herpetic Keratitis: Dendritic ulcer (fluorescein stain), photophobia, treat with acyclovir.
 • Pseudomonas Keratitis (Contact Lens Users): Ring infiltrate, rapid progression →
Ciprofloxacin drops.
• Fungal Keratitis (Farmers): Feathery margins, trauma with vegetative matter →
Natamycin.

7. Uveitis

• Symptoms: Pain, photophobia, ciliary congestion, miosis, low IOP.

• Key Sign: Keratic precipitates (KPs) + cells in anterior chamber.
• Treatment: Steroids (Prednisolone drops) + Cycloplegics (Atropine).

8. Glaucoma

Type Features Treatment

Open- Painless, gradual vision loss, cupped Prostaglandins (Latanoprost) →

Angle disc βblockers (Timolol)

Angle- Sudden pain, nausea, fixed middilated IV Mannitol → Pilocarpine → Laser

Closure pupil, high IOP iridotomy

9. Retinal Disorders

• Diabetic Retinopathy:
o NPDR: Microaneurysms, hemorrhages, hard exudates.
o PDR: Neovascularization → Pan-retinal photocoagulation (PRP).
• Retinal Vein Occlusion (CRVO): Flame hemorrhages, venous dilatation → Macular
edema → Anti-VEGF (Ranibizumab).
• Retinal Detachment: Flashes & floaters → curtain-like vision loss → Urgent surgery.

10. Neuro-Ophthalmology

• Optic Neuritis: Pain on eye movement, RAPD (Marcus Gunn pupil), normal fundus
initially → MRI (MS risk).
Horner’s Syndrome: Ptosis + Miosis + Anhidrosis → Sympathetic chain lesion
(Pancoast tumor, carotid dissection).
CN Palsies:
o CN III (Oculomotor): Ptosis, down & out eye, pupil involved (aneurysm). o CN
IV (Trochlear): Vertical diplopia, head tilt (trauma).

•
•

o CN VI (Abducens): Cannot abduct (raised ICP, diabetes).

11. Trauma & Emergencies

• Chemical Burns: Immediate irrigation (30 mins), pH check.

• Ruptured Globe: Do NOT patch, shield → Urgent surgery.
• Corneal FB: Remove with needle, check for rust ring.

12. Pediatric Ophthalmology

• Congenital Nasolacrimal Duct Obstruction: Crigler massage, resolves by 1 year.

• Amblyopia: Occlusion therapy (patch good eye).
• Strabismus: Hirschberg test, esotropia (inward), exotropia (outward).

13. Vitamin A Deficiency

• Early Sign: Conjunctival xerosis.

• Late Signs: Bitot’s spots, corneal xerosis → keratomalacia (blindness).
• Treatment: High-dose Vitamin A.

14. Drug Mechanisms

• Atropine: Cycloplegic + Mydriatic (contraindicated in glaucoma).

• Pilocarpine: Miotic (opens angle in glaucoma).
• Latanoprost: ↑ Uveoscleral outflow (PG analogue).
• Fluoroquinolones (Ciprofloxacin): Inhibit DNA gyrase.

Key Mnemonics:

• CRVO: "Blood & thunder" retina (hemorrhages).

• CRAO: Cherry-red spot (central retinal artery occlusion).
• Papilledema: Bilateral disc swelling (ICP↑, headache).
PHARMACOLOGY

✅ Drugs of Choice

Respiratory

• Acute bronchial asthma – Salbutamol

• COPD – Anticholinergics (Tiotropium, Ipratropium)
• Aspirin-induced asthma – Leukotriene inhibitors (Zafirlukast, Montelukast)

Infections

• MRSA – Vancomycin
• VRSA – Linezolid
• Amebiasis / Giardiasis / Trichomoniasis / C. difficile – Metronidazole
• Syphilis – Benzathine Penicillin
• Systemic fungal infection – Amphotericin-B
• HSV/Shingles – Acyclovir
• Malaria in pregnancy – Chloroquine

CNS

• Absence seizure – Ethosuximide

GTCS – Valproate
Partial seizures – Carbamazepine

•
•
•
•
Eclampsia – Magnesium sulfate
Status epilepticus – Lorazepam
• Anaphylaxis – Epinephrine

Endocrine/Metabolic

• DM Type 1 – Insulin
• DM Type 2 – Metformin
• DKA – Crystalline insulin
• Hyperprolactinemia – Bromocriptine
• Hypothyroidism – Levothyroxine
• Hyperthyroidism in pregnancy – Propylthiouracil

CVS

• AF – Digoxin
• SVT – Adenosine
• Prinzmetal angina – Nitroglycerin
• Pulmonary edema – Furosemide
• HTN in pregnancy – Methyldopa, Labetalol

Others

• Migraine – Sumatriptan
• Gout (acute) – NSAIDs
• Cerebral edema – Mannitol
• Osteoporosis prevention – Bisphosphonates
• Motion sickness – Scopolamine
• Traveler’s diarrhea – Diphenoxylate, Norfloxacin
•
•
🧪 Antidotes

• Paracetamol – N-acetylcysteine
• Benzodiazepine – Flumazenil
• Heparin – Protamine sulfate
Warfarin – Vitamin K (delayed), FFP (immediate)
Opioids – Naloxone
• Organophosphates – Atropine > Pralidoxime
• Digoxin – Digoxin Fab
• Magnesium sulfate – Calcium gluconate
• Isoniazid – Pyridoxine (B6)

⚠️ Common Drug Side Effects

• ACE inhibitors – Cough, angioedema, hyperkalemia

• Amphotericin B – Nephrotoxicity
• Atropine – Dry mouth, constipation
• Ciprofloxacin – Tendon rupture
• Clozapine – Agranulocytosis
• Lithium – Hypothyroidism, nephrogenic DI
• INH – Peripheral neuropathy, hepatitis
• Vincristine – Peripheral neuropathy
• Methotrexate – Pancytopenia, mucositis
• Amiodarone – QT prolongation, hypothyroidism, phototoxicity

🔬 Mechanism of Action

• Aminoglycosides / Tetracyclines – Inhibit 30S

• Macrolides / Clindamycin / Chloramphenicol – Inhibit 50S
• Vancomycin – Inhibits peptidoglycan synthesis

•
•
•
•
• Sulfonamides – Inhibit folate synthesis
• Methotrexate – Inhibits dihydrofolate reductase
• Rifampin – Inhibits RNA polymerase
• INH – Inhibits mycolic acid synthesis
• Fluoroquinolones – Inhibit DNA gyrase (topoisomerase)
• Statins – HMG CoA reductase inhibitors
Allopurinol – Xanthine oxidase inhibitor
Theophylline – PDE inhibitor → ↑cAMP
Steroids – Inhibit phospholipase A2
Finasteride – 5α-reductase inhibitor

ANATOMY
Here is a systematic summary of the high-yield ANATOMY points from the NLE Essence PDF:

🧠 Neuroanatomy

• CSF production:

• → 20 mL/hr; total daily production ≈ 450 mL

• → Formed by choroid plexus

• Sensory Receptors:

→ Pacinian corpuscles – Vibration, deep pressure

→ Ruffini corpuscles – Steady pressure, warmth

→ End bulb of Krause – Cold

•
•
→ Muscle spindle – Stretch reflex →

Golgi tendon organ – Tendon reflex

• CNS Lesions & Structures:

→ Chorea – Basal ganglia lesion

→ Intention tremor – Cerebellum lesion

•
•
→ Resting tremor – Substantia nigra (e.g., Parkinson’s)

→ Accommodation center – Cerebral cortex

→ Corneal reflex – Pons

→ Pupillary light reflex – Midbrain

→ Wernicke–Broca connection – Arcuate fasciculus

• Hemorrhages on CT Scan:

→ Subdural hematoma – Crescent-shaped

→ Epidural hematoma – Biconvex/lens-shaped

→ Subarachnoid hemorrhage – Severe headache + blood-tinged CSF

🦴 General Anatomy & Bone

• Most common site of aortic aneurysm – Infrarenal aorta

• Rupture of AAA – Left retroperitoneum is most common • CT angiography –
Investigation of choice for AAA
• Exostosis of EAC (Surfer’s ear):

→ Benign bony growth, multiple, bilateral, sessile, due to cold water exposure

→ CT shows broad-based lesion

• Osteoma:

→ Unilateral, pedunculated, outer part of EAC

→ Associated with Gardner syndrome

•
🔬 Microscopic Anatomy & Cells

Parafollicular cells (C cells) – Secrete calcitonin

Follicular cells of thyroid – Secrete T3 & T4
• Chief cells of parathyroid – Secrete PTH
• Cells most sensitive to hypoxia – Neurons
• Fat necrosis – Common in breast
• Coagulative necrosis – Common in heart, liver, kidney (not brain)

🧬 Embryology

• Congenital hydrocele – Due to patent processus vaginalis

• Hypertrophic pyloric stenosis – Congenital hypertrophy of pyloric muscle

High-Yield Pathology Points

1. Cellular Adaptations & Injury

• Atrophy: Decreased cell size (e.g., disuse atrophy, denervation).

• Hypertrophy: Increased cell size (e.g., LVH in hypertension, uterine hypertrophy in
pregnancy).
• Hyperplasia: Increased cell number (e.g., endometrial hyperplasia, BPH).
• Metaplasia: Replacement of one cell type with another (e.g., Barrett’s esophagus,
squamous metaplasia in smokers).
• Dysplasia: Disordered growth (premalignant).
• Necrosis vs. Apoptosis:
Necrosis: Inflammatory, pathological (coagulative, liquefactive, caseous, fat,
gangrenous).
Apoptosis: Programmed, non-inflammatory (e.g., embryogenesis, viral
hepatitis).

2. Inflammation & Repair

• Acute Inflammation:

•
•

Cardinal signs: Redness, swelling, heat, pain, loss of function.

Mediators: Histamine (immediate), prostaglandins (pain/fever), bradykinin
(pain).
Cells: Neutrophils (first responders).
• Chronic Inflammation:
Cells: Macrophages, lymphocytes, plasma cells.
Granuloma: Caseating (TB) vs. non-caseating (sarcoidosis).
• Healing:
Primary intention: Clean surgical wounds.
Secondary intention: Large wounds with granulation tissue.

3. Hemodynamic Disorders

• Edema:
Causes: ↑ Hydrostatic pressure (CHF), ↓ Oncotic pressure (nephrotic
syndrome).
• Thrombosis: Virchow’s triad (stasis, hypercoagulability, endothelial injury).
• Embolism:
DVT → PE (most common).
Fat embolism (long bone fractures).
Amniotic fluid embolism (DIC, hypoxia during labor).
• Infarction:
Pale (arterial occlusion, e.g., MI).
Hemorrhagic (venous occlusion, e.g., testicular torsion).

4. Immunopathology

• Hypersensitivity Reactions:
Type I (IgE): Anaphylaxis, asthma.
Type II (IgG/IgM): Autoimmune hemolytic anemia, Goodpasture’s.
Type III (Immune complex): SLE, post-streptococcal GN. Type
IV (T-cell): TB, contact dermatitis.
• Autoimmune Diseases:
SLE: Anti-dsDNA, anti-Smith.
Rheumatoid arthritis: RF, anti-CCP.
 • Amyloidosis: Congo red (+) with apple-green birefringence.

5. Neoplasia

Benign vs. Malignant:

•
 Benign: Well-differentiated, no metastasis.
Malignant: Poorly differentiated, invades/metastasizes.
• Carcinogenesis:
Oncogenes: RAS, MYC, HER2/neu.
Tumor suppressors: p53, Rb, BRCA1/2.
• Paraneoplastic Syndromes:
SIADH (small cell lung cancer).
Cushing’s (ACTH-secreting tumors).
Hypercalcemia (PTHrp in squamous cell carcinoma).

6. Genetic Disorders

• Autosomal Dominant: Huntington’s, Marfan’s, NF1.

• Autosomal Recessive: Cystic fibrosis, sickle cell, PKU.
• X-linked: Duchenne MD, hemophilia A/B.
• Triplet Repeat Disorders: Fragile X (CGG), Huntington’s (CAG).

7. Nutritional & Environmental Pathology

• Vitamin Deficiencies:
B1 (Thiamine): Beriberi, Wernicke-Korsakoff.
B3 (Niacin): Pellagra (3 D’s: Dermatitis, Diarrhea, Dementia).
B12/Folate: Megaloblastic anemia, neurologic symptoms (B12 only).
Vitamin C: Scurvy (gingival bleeding, poor wound healing).
• Toxins:
CO poisoning: Cherry-red skin, ↑ COHb.
Lead poisoning: Basophilic stippling, wrist/foot drop.

8. Infectious Disease Pathology

• Bacteria:
Staph aureus: Abscesses, endocarditis (IV drug users).
Strep pyogenes: Rheumatic fever (M protein), post-streptococcal GN.
• Viruses:
HPV: Koilocytes, cervical cancer (types 16/18).

•
 EBV: Mononucleosis (atypical lymphocytes), Burkitt’s lymphoma. Fungi:
Candida: Pseudohyphae, thrush (immunocompromised).
Aspergillus: Angioinvasive (neutropenic patients).

9. Hematopathology

• Anemias:
Microcytic: Fe deficiency (↓ ferritin), thalassemia (↑ HbA2).
Macrocytic: B12/folate deficiency (hypersegmented neutrophils).
Hemolytic: G6PD deficiency (Heinz bodies, bite cells).
• Leukemia/Lymphoma:
AML: Auer rods, myeloperoxidase (+).
CLL: Smudge cells, CD5/CD19 (+).
Hodgkin lymphoma: Reed-Sternberg cells (CD15/CD30 +).

10. Systemic Pathology Highlights

• Cardiac:
Atherosclerosis: LDL → foam cells → fibrous plaque → rupture.
MI complications: Papillary muscle rupture (MR), ventricular aneurysm.
• Pulmonary:
Emphysema: α1-antitrypsin deficiency (panacinar).
ARDS: Diffuse alveolar damage, hyaline membranes.
• Renal:
Nephritic syndrome: HTN, hematuria (post-streptococcal GN).
Nephrotic syndrome: Proteinuria, hypoalbuminemia (minimal change disease).
• Liver:
Cirrhosis: Bridging fibrosis, portal HTN.
Hepatitis:
Acute: Councilman bodies (apoptosis).
Chronic: Ground-glass hepatocytes (HBV).

Key Mnemonics

•
 • Granulomatous diseases: TB, Sarcoidosis, Crohn’s, Fungal, Beryllium (TSCFB).
Tumor markers:
CA-125 (ovary), PSA (prostate), CEA (colon).
• Hypersensitivity reactions: ACID (Type I – Anaphylactic, Type II – Cytotoxic, Type III –
Immune complex, Type IV – Delayed).
High-Yield Notes from Anatomy Shelf Notes

1. Lumbar Puncture & Epidural Anesthesia

• Entry Point: Between L3/L4 or L4/L5 (level of iliac crests).

• Structures Pierced: Skin → Fascia → Ligamentum flavum → Epidural space → Dura
mater → Subarachnoid space (CSF).
• Spinal Cord Ends:
o Adults: L1/L2.
o Children: L3.
• Dural Sac Ends: S2.
• Complication: Herniation if intracranial pressure is elevated.

2. Herniated IV Disc

• Common Sites: L4/L5 or L5/S1 (lumbar); C5/C6 or C6/C7 (cervical).

• Affected Nerve Root: Traversing root (e.g., L4/L5 herniation compresses L5).
• Mechanism: Nucleus pulposus herniates through anulus fibrosus, compressing spinal
nerve.

3. Spinal Curvature Abnormalities

• Kyphosis: Exaggerated thoracic curve (osteoporosis in elderly).

• Lordosis: Exaggerated lumbar curve (pregnancy, spondylolisthesis).
• Scoliosis: Lateral deviation (leg-length discrepancy, poliomyelitis).

4. Upper Limb Fractures

 • Humerus Fractures:
o Surgical Neck: Axillary nerve injury. o Midshaft: Radial nerve injury.

•
 o Medial Epicondyle: Ulnar nerve injury.
• Colles’ Fracture: Distal radius fracture with dorsal displacement ("dinner fork
deformity").
• Scaphoid Fracture:
o Tenderness in anatomical snuffbox.
o Risk of avascular necrosis (proximal fragment).

5. Rotator Cuff Muscles (SITS)

• Supraspinatus, Infraspinatus, Teres minor, Subscapularis.

• Function: Stabilize shoulder joint; supraspinatus initiates abduction (0°–15°).

6. Carpal Tunnel Syndrome

• Cause: Compression of median nerve in carpal tunnel.

• Symptoms: o Numbness in lateral 3.5 fingers (spares palm).
o Ape hand deformity (loss of opposition).

7. Brachial Plexus Injuries

• Erb-Duchenne Palsy (C5–C6): o "Waiter’s tip" posture (adducted shoulder, medially

rotated arm).
• Klumpke Palsy (C8–T1):
o Claw hand (ulnar nerve) + ape hand (median nerve).

8. Lower Limb Injuries

• Femoral Neck Fracture: Risk of avascular necrosis (disrupted retinacular arteries).

• Unhappy Triad (Knee):
o Tibial collateral ligament + Medial meniscus + Anterior cruciate ligament (ACL).
• Ankle Sprain: Inversion injury damages anterior talofibular ligament.

9. Abdominal Hernias
 • Indirect Inguinal Hernia: o Congenital; passes lateral to inferior epigastric vessels.
• Direct Inguinal Hernia:
o Acquired; passes medial to inferior epigastric vessels (Hesselbach’s triangle).

10. Gastrointestinal Anatomy

• Foregut/Midgut/Hindgut:
o Foregut: Supplied by celiac artery (T5–T9); pain referred to epigastrium. o
Midgut: Supplied by SMA (T10–T11); pain referred to umbilicus.
o Hindgut: Supplied by IMA (L1–L2); pain referred to hypogastrium.
• Appendicitis:
o Early pain at umbilicus (visceral); later shifts to McBurney’s point (parietal).

11. Portal Hypertension

• Portacaval Anastomoses:
o Esophageal varices (left gastric vein + azygos vein).
o Caput medusae (paraumbilical veins + epigastric veins).
o Hemorrhoids (superior rectal vein + inferior rectal vein).

12. Cranial Nerves

• Facial Nerve (CN VII):

o Bell’s Palsy: Ipsilateral facial paralysis, dry eye, loss of taste (anterior 2/3
tongue).
• Oculomotor Nerve (CN III):
o Palsy: Ptosis, "down and out" eye, dilated pupil.
• Horner Syndrome:
o Miosis, ptosis, anhydrosis (disrupted sympathetic pathway).

13. Thyroid & Parathyroid

• Thyroid:
o Superior laryngeal nerve (external branch) at risk during thyroidectomy.
 o Recurrent laryngeal nerve injury → hoarseness.
• Parathyroid:
o PTH increases blood calcium; calcitonin decreases it.

14. Larynx

• Vocal Cord Innervation:

o Recurrent laryngeal nerve (all muscles except cricothyroid).
o Cricothyroid muscle (external laryngeal nerve).

15. Emergency Procedures

• Cricothyrotomy: Incision through cricothyroid membrane for airway obstruction.

Key Mnemonics

• Rotator Cuff: SITS (Supraspinatus, Infraspinatus, Teres minor, Subscapularis).

• Foregut/Midgut/Hindgut: CA (celiac), SMA, IMA.
• Brachial Plexus Roots: "Randy Travis Drinks Cold Beer" (Roots, Trunks, Divisions, Cords,
Branches).

High-Yield Revision Points Gynae and Obs

1. Pregnancy & Labour

• Terminology:
Term pregnancy: 37–42 weeks
Preterm labour: <37 weeks Post-
term pregnancy: >42 weeks
• Stages of labour:
1st stage: Cervical dilation (latent & active phases)
2nd stage: Full dilation to delivery
 3rd stage: Placental delivery (expectant vs. active management)
• Induction of labour:
Indications: Post-term, preeclampsia, IUGR
Methods: Prostaglandins (PGE2), oxytocin, ARM

2. Medical Disorders in Pregnancy

• Hypertensive disorders:
Gestational HTN: New HTN after 20 weeks, no proteinuria
Preeclampsia: HTN + proteinuria/organ dysfunction
Eclampsia: Preeclampsia + seizures (treat with MgSO₄)
HELLP syndrome: Hemolysis, elevated LFTs, low platelets
• Diabetes in pregnancy:
GDM: Screen at 24–28 weeks (OGTT)
Management: Diet → insulin (oral agents avoided)
• Thromboembolism:
LMWH is anticoagulant of choice

3. Malpresentation & Multiple Pregnancy

• Breech presentation:
Types: Frank, complete, footling
Management: ECV at 37 weeks → C-section if unsuccessful
• Transverse lie:
Risk factors: Multiparity, polyhydramnios
Delivery: C-section (vaginal delivery contraindicated)
• Twin pregnancy:
Dichorionic diamniotic (DCDA): Lowest risk
Monochorionic monoamniotic (MCMA): Highest risk (cord entanglement)
Delivery: Vaginal if Twin A cephalic, C-section if complications
4. Liquor Volume Abnormalities

• Polyhydramnios (AFI >24 cm):

Causes: GDM, fetal anomalies (e.g., duodenal atresia)
• Oligohydramnios (AFI <5 cm):
 Causes: PPROM, IUGR, renal anomalies
Management: Amnioinfusion if severe

5. Obstetric Emergencies

• Placental abruption:
Classic triad: Painful bleeding, uterine tenderness, fetal distress
Management: Emergency delivery
• Uterine rupture:
Risk factors: Previous C-section, uterine surgery Signs:
Sudden pain, fetal distress, loss of contractions
• Shoulder dystocia:
McRoberts maneuver (first-line)
Complication: Erb’s palsy

Gynecology Topics

6. Puberty

• Normal puberty:
Thelarche (breast buds) → Pubarche → Menarche
Delayed puberty: No breast development by 13 or no menarche by 15
• Primary amenorrhea:
Turner syndrome (45X): Streak ovaries, high FSH
Imperforate hymen: Cyclical pain, bulging membrane

7. Infertility

• Causes:
Male factor: Low sperm count/motility
Female factor: PCOS, tubal blockage, endometriosis
• Investigations:
Day 3 FSH/LH, HSG, semen analysis
• Treatment:
Clomiphene (ovulation induction) → IUI → IVF
8. Contraception

• Combined hormonal (COCP):

Contraindications: HTN, smokers >35, history of VTE
• Progesterone-only (POP):
Safe in breastfeeding, VTE risk
• LARC (Long-acting reversible):
Copper IUD: Emergency contraception
Levonorgestrel IUS (Mirena): Treats heavy bleeding

9. Menstrual Disorders

• Heavy menstrual bleeding (HMB):

Causes: Fibroids, adenomyosis, coagulopathy (e.g., von Willebrand)
Treatment: Tranexamic acid, hormonal IUD, endometrial ablation
• Dysmenorrhea:
Primary: No pathology (treat with NSAIDs)
Secondary: Endometriosis, PID

10. Sexual Disorders

• Dyspareunia (painful sex):

Superficial: Vaginismus, vulvodynia
Deep: Endometriosis, PID •
Hypoactive sexual desire disorder:
Postpartum: Low estrogen (breastfeeding)

11. Urinary Problems

• Stress incontinence:
Pelvic floor exercises (1st line) → Midurethral sling
• Overactive bladder:
Anticholinergics (oxybutynin), mirabegron

12. Uterovaginal Prolapse

 • Grades:
1st: Descent to introitus
2nd: Protrudes outside
3rd/4th: Complete procidentia
• Management:
Pessary (1st line in elderly) → Surgery (hysterectomy + repair)

13. Genital Tract Infections

• Bacterial vaginosis:
Clue cells, fishy odor → Metronidazole
• Candidiasis:
Itching, cottage cheese discharge → Fluconazole
• PID:
Cervical motion tenderness → Ceftriaxone + Doxycycline

14. Gynecological Tumors

• Endometrial cancer:
Postmenopausal bleeding → Hysterectomy
• Ovarian cancer:
Silent tumor → CA-125, ultrasound
Risk factors: BRCA, Lynch syndrome

Key Mnemonics

• HELLP syndrome: Hemolysis, Elevated LFTs, Low Platelets

• PID treatment: CDC (Ceftriaxone, Doxycycline, Cover anaerobes with metronidazole if
abscess)
• Polyhydramnios causes: Diabetes, Duodenal atresia, Down syndrome

Internal Medicine
Endocrinology
1. Pituitary Gland

• Anterior Pituitary (Adenohypophysis):

o Prolactinoma: Most common functional pituitary adenoma → galactorrhea,
amenorrhea, infertility (treated with dopamine agonists like
bromocriptine/cabergoline).
o Growth Hormone (GH) Excess:
 Before epiphyseal closure: Gigantism.
 After closure: Acromegaly (enlarged hands/feet, coarse facial features,
macroglossia, carpal tunnel syndrome).
 Diagnosis: Elevated IGF-1, failure to suppress GH on oral glucose
tolerance test (OGTT). o Cushing’s Disease: ACTH-secreting adenoma →
high cortisol (diagnose with dexamethasone suppression test). o
Sheehan’s Syndrome: Postpartum pituitary necrosis (hypotension +
failure to lactate + amenorrhea).
• Posterior Pituitary (Neurohypophysis):
o Diabetes Insipidus (DI):
 Central DI: ADH deficiency (head trauma, tumors) → low urine
osmolality, high serum osmolality (treat with desmopressin (dDAVP)).
 Nephrogenic DI: ADH resistance (lithium, hypercalcemia) → no response
to dDAVP (treat with thiazides + low-salt diet). o SIADH: High ADH →
hyponatremia, high urine osmolality, low serum osmolality (treat with
fluid restriction, demeclocycline).

2. Thyroid Disorders

• Hyperthyroidism:
o Graves’ Disease: TSI antibodies → diffuse goiter, exophthalmos, pretibial
myxedema (treat with methimazole/propylthiouracil (PTU) or radioactive
iodine).
o Thyroid Storm: Tachycardia, fever, agitation (treat with PTU (blocks synthesis +
conversion), beta-blockers, steroids, iodine).
o Toxic Multinodular Goiter: Hot nodules on scan (no autoantibodies).
• Hypothyroidism:
 o Hashimoto’s Thyroiditis: Anti-TPO antibodies → goiter, weight gain,
bradycardia, myxedema coma (treat with levothyroxine). o Myxedema Coma:
Hypothermia, bradycardia, coma (treat with IV levothyroxine + steroids).
• Thyroid Nodules/Cancer:
o Most common type: Papillary carcinoma (Psammoma bodies, lymphatic
spread). o Medullary carcinoma: Calcitonin secretion, associated with MEN
2A/2B (RET proto-oncogene).
o Anaplastic carcinoma: Aggressive, poor prognosis.

3. Adrenal Gland

• Cushing’s Syndrome:
o Causes: Pituitary adenoma (Cushing’s disease), adrenal adenoma, ectopic ACTH
(small cell lung cancer), exogenous steroids. o Findings: Moon facies, buffalo
hump, striae, hyperglycemia, osteoporosis.
o Diagnosis: High-dose dexamethasone suppression test (suppresses if pituitary
source).
• Primary Hyperaldosteronism (Conn’s Syndrome):
o Hypokalemia, metabolic alkalosis, hypertension (low renin, high aldosterone).
o Diagnosis: Elevated aldosterone/renin ratio (treat with spironolactone).
• Addison’s Disease (Primary Adrenal Insufficiency):
o Causes: Autoimmune (most common), TB, metastatic disease.
o Findings: Fatigue, hyperpigmentation, hyponatremia, hyperkalemia,
hypoglycemia.
o Diagnosis: Low cortisol, high ACTH (treat with glucocorticoids +
mineralocorticoids).
• Pheochromocytoma: o Rule of 10s: 10% bilateral, 10% malignant, 10% extra-adrenal. o
Findings: Episodic hypertension, headache, sweating, palpitations.
o Diagnosis: 24-hour urine metanephrines (treat with alpha-blockers first
(phenoxybenzamine), then beta-blockers).

4. Diabetes Mellitus (DM)

• Type 1 DM: Autoimmune (anti-GAD antibodies), absolute insulin deficiency, DKA risk.
• Type 2 DM: Insulin resistance, associated with metabolic syndrome (obesity, HTN,
dyslipidemia).
 • Complications:
o Microvascular: Retinopathy, nephropathy (Kimmelstiel-Wilkin nodules),
neuropathy.
o Macrovascular: CAD, stroke, PVD. o DKA: High anion gap metabolic acidosis,
ketones, Kussmaul breathing (treat with IV fluids, insulin, potassium).
o HHS: Hyperosmolar state without significant ketosis (higher mortality than
DKA).

5. Calcium & Bone Disorders

• Hyperparathyroidism:
o Primary: High PTH, high calcium (adenoma) → osteitis fibrosa cystica,
nephrolithiasis.
o Secondary: High PTH, low calcium (chronic kidney disease).
• Hypoparathyroidism: Low PTH, low calcium (post-thyroidectomy) → Chvostek’s &
Trousseau’s signs.
• Hypercalcemia of Malignancy: PTHrP secretion (squamous cell lung cancer, breast
cancer).
• Osteoporosis: DEXA scan (T-score ≤ -2.5), treat with bisphosphonates.

6. Reproductive Endocrinology

• PCOS: Oligomenorrhea, hirsutism, insulin resistance, LH:FSH > 2:1.

• Klinefelter’s (47,XXY): Tall, gynecomastia, small testes, infertility.
• Turner’s (45,X): Short stature, webbed neck, coarctation of aorta, primary
amenorrhea.

7. Miscellaneous

• MEN Syndromes: o MEN 1 (3 P’s): Pituitary, Pancreatic (gastrinoma), Parathyroid.

o MEN 2A: Medullary thyroid cancer, Pheochromocytoma, Hyperparathyroidism.
o MEN 2B: Medullary thyroid cancer, Pheochromocytoma, Marfanoid habitus,
mucosal neuromas.

Key Labs & Diagnostic Tests

 • ACTH Stimulation Test: Diagnoses adrenal insufficiency.
• Water Deprivation Test: Differentiates DI vs. psychogenic polydipsia.
• Dexamethasone Suppression Test: Diagnoses Cushing’s.

Gastroenterology
1. Esophagus

• GERD:
o Symptoms: Heartburn, regurgitation, chronic cough, hoarseness.
o Complications: Barrett’s esophagus (intestinal metaplasia → adenocarcinoma),
strictures.
o Diagnosis: Endoscopy (gold standard), pH monitoring. o Treatment: PPIs (1st-
line), H2 blockers, lifestyle changes (avoid fatty foods, caffeine, alcohol).
• Achalasia:
o Pathology: Loss of myenteric (Auerbach’s) plexus → failure of LES relaxation.
o Symptoms: Dysphagia (solids > liquids), regurgitation of undigested food, bird’s
beak on barium swallow.
o Diagnosis: Esophageal manometry (gold standard).
o Treatment: Pneumatic dilation, Heller myotomy, Botox injection.
• Boerhaave Syndrome:
o Full-thickness esophageal rupture (after vomiting) → mediastinitis,
subcutaneous emphysema, Hamman’s crunch.
o Treatment: Emergency surgery + antibiotics.

2. Stomach & Peptic Ulcer Disease (PUD)

• PUD Causes:
o H. pylori (most common, urea breath test for diagnosis). o NSAIDs (COX-1
inhibition → ↓PGE2 → ↓mucosal protection). o Zollinger-Ellison Syndrome
(gastrinoma → high acid secretion → multiple ulcers).
• Complications:
o Bleeding (most common).
o Perforation: Sudden severe abdominal pain, rigid abdomen, free air under
diaphragm on X-ray.
o Gastric Outlet Obstruction: Non-bilious vomiting, succussion splash.
 • Treatment:
o H. pylori: PPI + clarithromycin + amoxicillin/metronidazole (triple therapy).
o NSAID-induced: Stop NSAIDs + PPI.

3. Liver Disease

• Cirrhosis & Portal Hypertension:

o Causes: Alcohol, hepatitis B/C, NASH.
o Complications:
 Esophageal varices (treat acute bleed with octreotide + band ligation).
 Ascites (diagnose with SAAG >1.1, treat with spironolactone +
furosemide).
 Hepatic encephalopathy (↑ammonia, treat with lactulose + rifaximin).
 Hepatorenal syndrome (oliguria, ↑Cr, treat with midodrine +
octreotide).
• Hepatitis:
o Hep B: HBsAg (active infection), Anti-HBc (exposure), Anti-HBs (immunity).
o Hep C: Most common cause of chronic hepatitis → cirrhosis/HCC (treat with
direct-acting antivirals).
• Liver Tumors:
o Hepatocellular Carcinoma (HCC): ↑AFP, associated with cirrhosis, hepatitis B/C.
o Metastases: Most common liver tumor (colon, breast, lung primaries).

4. Biliary & Pancreatic Disease

• Gallstones:
o Cholelithiasis: Asymptomatic. o Cholecystitis: RUQ pain, Murphy’s sign, fever
(treat with cholecystectomy).
o Choledocholithiasis: Jaundice, ↑ALP, ↑bilirubin (diagnose with MRCP, treat
with ERCP).
• Acute Pancreatitis:
o Causes: GET SMASHED (Gallstones, Ethanol, Trauma, Steroids, Mumps,
Autoimmune, Scorpion sting, Hyperlipidemia, ERCP, Drugs). o Diagnosis:
↑Lipase (more specific than amylase), CT findings.
o Complications: Pseudocyst (4 weeks later), necrotizing pancreatitis.
• Chronic Pancreatitis:
 o Causes: Alcohol most common.
o Findings: Steatorrhea (fat malabsorption), calcifications on X-ray, DM (loss of
islets).

5. Inflammatory Bowel Disease (IBD)

• Crohn’s Disease:
o Transmural inflammation, skip lesions, cobblestone mucosa, fistulas, non-
caseating granulomas. o Extraintestinal: Erythema nodosum, uveitis,
ankylosing spondylitis (HLAB27).
o Treatment: Steroids, anti-TNF (infliximab), surgery (no cure).
• Ulcerative Colitis:
o Limited to colon, continuous inflammation, crypt abscesses, no granulomas.
o Extraintestinal: Primary sclerosing cholangitis (PSC), pyoderma gangrenosum.
o Toxic Megacolon: Medical emergency (abdominal distension, fever,
tachycardia).
o Treatment: 5-ASA (mesalamine), colectomy (curative).

6. Colon & Small Bowel Disorders

• Diverticulosis:
o Asymptomatic outpouchings, risk ↑ with age.
o Diverticulitis: LLQ pain, fever, leukocytosis (treat with antibiotics).
• Celiac Disease:
o Autoimmune (anti-tTG, anti-endomysial antibodies), villous atrophy, diarrhea,
bloating.
o Treatment: Gluten-free diet.
• Colorectal Cancer:
o Most common site: Rectosigmoid.
o Screening: Colonoscopy at 45+ (earlier if familial polyposis, Lynch syndrome).

7. GI Bleeding

• Upper GI Bleed (UGIB):

o Causes: PUD, varices, Mallory-Weiss tear. o Diagnosis: EGD.
• Lower GI Bleed (LGIB):
 o Causes: Diverticulosis (most common), angiodysplasia, hemorrhoids.
o Diagnosis: Colonoscopy.

8. Miscellaneous High-Yield Facts

• Appendicitis: RLQ pain, McBurney’s tenderness, ↑WBC, Rovsing’s sign.

• Hereditary Hemochromatosis: ↑Fe, ↑ferritin, ↑TSAT, cirrhosis, DM, cardiomyopathy.
• Wilson’s Disease: ↓Ceruloplasmin, Kayser-Fleischer rings, neuropsych symptoms.

Key Labs & Imaging

• AST/ALT Ratio: >2 in alcoholic hepatitis.

• Ammonia: ↑ in hepatic encephalopathy.
• Barium Swallow: Bird’s beak (achalasia), corkscrew (esophageal spasm).

Neurology
1. Stroke & Cerebrovascular Disease

• Ischemic Stroke (80%):

o Thrombotic: Atherosclerosis (MCA most common). o Embolic: Atrial fibrillation
(cardioembolic), MCA territory most affected.
o Lacunar Strokes: Small vessel disease (hypertension, diabetes) → pure motor
(internal capsule), pure sensory (thalamus), ataxic hemiparesis (pons). o
Diagnosis: Non-contrast CT first (rule out hemorrhage), MRI diffusionweighted
imaging (DWI) gold standard. o Treatment: tPA within 4.5 hrs (exclude
hemorrhage, recent surgery, anticoagulation).
• Hemorrhagic Stroke (20%):
o
Hypertensive hemorrhage: Basal ganglia, thalamus, pons, cerebellum.
o Subarachnoid Hemorrhage (SAH): Thunderclap headache, nuchal rigidity,
Fisher Grade 3 = highest vasospasm risk.
 Cause: Berry aneurysm (most commonly at anterior communicating
artery).
 Diagnosis: CT → LP if negative (xanthochromia).
 Treatment: Nimodipine (prevents vasospasm), surgical clipping/coiling.
• Transient Ischemic Attack (TIA):
o Neurologic deficits resolving <24 hrs (usually <1 hr).
o ABCD2 score predicts stroke risk.

2. Seizures & Epilepsy

• Focal Seizures:
o With impaired awareness (complex partial): Temporal lobe (olfactory/psychic
auras, automatisms). o Without impaired awareness: Motor (Jacksonian march)
or sensory symptoms.
• Generalized Seizures:
o Tonic-clonic (grand mal): Postictal confusion, tongue biting. o Absence (petit
mal): 3 Hz spike-and-wave EEG, no postictal state. o Atonic: Sudden loss of tone
("drop attacks").
o Myoclonic: Sudden jerks (e.g., Juvenile Myoclonic Epilepsy).
• Status Epilepticus: >5 mins of seizure or recurrent without recovery → IV lorazepam,
then fosphenytoin.
• First-line drugs:
o Focal: Levetiracetam, carbamazepine.
o Generalized: Valproate (avoid in pregnancy → neural tube defects).

3. Headache

• Migraine:
o With aura (scintillating scotoma, paresthesias), photophobia, phonophobia.
Treatment: Triptans (contraindicated in CAD, stroke), propranolol/topiramate
for prophylaxis.
• Cluster Headache:
o
o Unilateral, periorbital, Horner’s syndrome (ptosis, miosis).
o Treatment: High-flow O2, sumatriptan.
• Trigeminal Neuralgia:
o Unilateral stabbing pain (V2/V3 distribution) → carbamazepine.
• Idiopathic Intracranial Hypertension (Pseudotumor cerebri):
o Obese women, papilledema, headache, visual loss.
o Treatment: Acetazolamide, LP, weight loss.

4. Neurodegenerative Disorders

• Alzheimer’s Disease:
o Memory loss (early short-term), apraxia, aphasia. o Pathology: Amyloid
plaques (Aβ), neurofibrillary tangles (tau).
o Treatment: AChE inhibitors (donepezil), memantine (NMDA antagonist).
• Parkinson’s Disease:
o TRAP: Tremor (pill-rolling), Rigidity (cogwheel), Akinesia/bradykinesia, Postural
instability.
o Pathology: Lewy bodies (α-synuclein), substantia nigra degeneration.
o Treatment: Levodopa/carbidopa (gold standard), dopamine agonists
(pramipexole).
• ALS (Lou Gehrig’s Disease):
o UMN + LMN signs (spasticity + atrophy, no sensory loss).
o No cure (riluzole modestly prolongs survival).

5. Demyelinating Diseases

• Multiple Sclerosis (MS):

o Relapsing-remitting (most common), optic neuritis, internuclear
ophthalmoplegia (INO), Lhermitte’s sign.
o Diagnosis: MRI (periventricular plaques), CSF oligoclonal bands.
o Treatment: Steroids (acute), interferon-β/glatiramer (prevention).
• Guillain-Barré Syndrome:
Ascending paralysis, areflexia, albuminocytologic dissociation (↑CSF protein,
normal WBC).
o Treatment: IVIG or plasmapheresis.
o

6. CNS Infections

• Meningitis:
o Bacterial (S. pneumoniae, N. meningitidis): Neck stiffness, fever,
Kernig’s/Brudzinski’s signs → empiric ceftriaxone + vancomycin +
dexamethasone.
o Viral (enterovirus): Lymphocytic CSF, self-limiting.
• Encephalitis: o HSV-1: Temporal lobe necrosis (MRI), acyclovir treatment.
• Brain Abscess:
o Ring-enhancing lesion, Streptococci/Staphylococci → surgical drainage +
antibiotics.

7. Spinal Cord & Peripheral Nerve

• Spinal Cord Compression:

o Emergency: Back pain, weakness, sensory level, bowel/bladder dysfunction.
o Causes: Metastasis (most common), epidural abscess.
• Brown-Séquard Syndrome:
o Hemisection: Ipsilateral weakness + loss of vibration/proprioception,
contralateral loss of pain/temp.
• Peripheral Neuropathy:
o Diabetes: Glove-and-stocking distribution. o B12 Deficiency: Subacute
combined degeneration (posterior + lateral columns).

8. High-Yield Syndromes

• Horner’s Syndrome: Ptosis, miosis, anhidrosis (Pancoast tumor, carotid dissection).

 • Wernicke-Korsakoff: Confusion, ataxia, nystagmus (Wernicke) + confabulation
(Korsakoff) → thiamine deficiency.
• Syringomyelia: Bilateral loss of pain/temp in "cape-like" distribution (central cord
lesion).

Key Reflexes & Localization

• Babinski Sign: UMN lesion (toes dorsiflex).

• LMN Lesion: Hyporeflexia, atrophy, fasciculations.
• UMN Lesion: Hyperreflexia, spasticity, clasp-knife rigidity.

Must-Know Drugs & Toxins

• Warfarin Toxicity: Vitamin K + FFP.

• Opioid Overdose: Pinpoint pupils, naloxone reversal.
• Anticholinergic Toxicity: Hot as a hare, dry as a bone, red as a beet, mad as a hatter.

Cardiology

1. Coronary Artery Disease (CAD) & Acute Coronary Syndrome (ACS)

• Stable Angina:
o Symptoms: Chest pain (crushing, substernal) radiating to left arm/jaw, relieved
by rest/nitroglycerin.
o Diagnosis: Stress test (exercise ECG), coronary angiography (gold standard). o
Treatment: Nitrates, beta-blockers (1st-line), CCBs (if beta-blockers
contraindicated).
• Unstable Angina/NSTEMI:
o Symptoms: Angina at rest, ↑Troponin (NSTEMI), normal ST on ECG.
o Treatment: Aspirin + P2Y12 inhibitor (clopidogrel), heparin, statin, early
invasive strategy (PCI).
 • STEMI:
o ECG Findings: ST elevation (>1mm in 2+ contiguous leads), reciprocal ST
depression.
o Treatment: Reperfusion ASAP → PCI (preferred) or fibrinolytics (tPA if PCI >90
min away).
o Complications:
 Ventricular arrhythmias (VF/VT) → defibrillation.
 Cardiogenic shock (↓BP, pulmonary edema) → inotropes
(dobutamine), IABP.
 Papillary muscle rupture → acute mitral regurgitation (holosystolic
murmur).

2. Heart Failure (HF)

• Systolic HF (HFrEF, EF <40%):

o Causes: Ischemic cardiomyopathy, dilated cardiomyopathy (DCM).
o Treatment: ACEI/ARB + beta-blocker (carvedilol/metoprolol) + spironolactone
+ SGLT2 inhibitors.
• Diastolic HF (HFpEF, EF ≥50%):
o Causes: HTN, hypertrophic cardiomyopathy (HCM), amyloidosis.
o Treatment: Diuretics (symptom relief), BP control.
• Acute Decompensated HF:
o Symptoms: Dyspnea, crackles, S3 gallop, JVD, peripheral edema.
o Treatment: Diuretics (furosemide), vasodilators
(nitroprusside/nitroglycerin), inotropes (dobutamine if hypotensive).

3. Valvular Heart Disease

V
al Stenosis Regurgitation
ve
 A
or Systolic ejection murmur (SEM), Early diastolic decrescendo murmur, wide pulse
ti syncope, angina, S4 pressure, bounding pulses
c

M
Diastolic rumble, opening snap, LA
itr Holosystolic murmur at apex, radiating to axilla
enlargement (afib)
al

• Aortic Stenosis: Triad → Syncope, angina, dyspnea.

• Mitral Regurgitation: Acute (papillary muscle rupture) → pulmonary edema.
• Mitral Valve Prolapse: Mid-systolic click + late systolic murmur, anxiety, tall/thin body
habitus.

4. Arrhythmias

• Atrial Fibrillation (A-fib):

o Irregularly irregular pulse, no P waves.
o Treatment:
 Rate control (beta-blockers, CCBs, digoxin).
 Rhythm control (amiodarone, cardioversion if unstable). 
Anticoagulation (CHADS₂-VASc ≥2 → warfarin/DOACs).
• Ventricular Tachycardia (VT):
o Wide QRS, no P waves. o Treatment: Unstable → cardioversion, stable →
amiodarone/lidocaine.
•

Bradycardia:
o Sinus node dysfunction (sick sinus syndrome) → pacemaker.
o AV Blocks:
 1st-degree: PR >200ms.
 2nd-degree (Type I: Wenckebach): PR prolongation → dropped QRS.
 3rd-degree (Complete): P waves and QRS dissociated → pacemaker.

5. Hypertension (HTN)

• Essential (Primary) HTN (90%): No identifiable cause.

• Secondary HTN Causes:
o Renal artery stenosis → ↑Renin, unilateral small kidney. o
Pheochromocytoma → Episodic HTN, ↑catecholamines.
o Cushing’s → ↑Cortisol, moon facies.
• Hypertensive Emergency: BP >180/120 + end-organ damage (encephalopathy, renal
failure, papilledema) → IV nitroprusside/labetalol.

6. Cardiomyopathies

Type Key Features Treatment

Dilated (DCM) ↓EF, S3, global hypokinesis ACEI, beta-blockers

Hypertrophic LV hypertrophy, diastolic dysfunction, systolic Beta-blockers, avoid

(HCM) murmur ↑ with Valsalva nitrates/diuretics

Restrictive ↑LV wall thickness, "sparkling" myocardium Supportive, poor

(Amyloidosis) on echo prognosis

7. Pericardial Disease

• Acute Pericarditis:
o Chest pain improved by sitting forward, pericardial friction rub.
o ECG: Diffuse ST elevation, PR depression.
o Treatment: NSAIDs + colchicine.
 • Cardiac Tamponade:
o Beck’s Triad: Hypotension, JVD, muffled heart sounds. o Pulsus paradoxus
(>10 mmHg drop in BP with inspiration).
o Treatment: Pericardiocentesis (emergency).

8. Congenital Heart Disease

Shunt
Defect Key Features
Direction

ASD L→R Fixed split S2, pulmonary flow murmur

VSD L→R Holosystolic murmur at LSB

PDA L→R Continuous "machine-like" murmur

Tetralogy of 4 features: VSD, RVH, overriding aorta, PS →

R→L
Fallot "Cyanotic spells"

9. High-Yield Pharmacology

• Beta-Blockers: ↓HR, ↓BP (avoid in asthma, decompensated HF).

• CCBs:
o Dihydropyridines (amlodipine) → vasodilation.
o Non-DHP (verapamil/diltiazem) → ↓HR, avoid in HF.
• Digoxin: ↑Contractility, ↓HR (toxicity → nausea, yellow vision, arrhythmias).
• Nitrates: Venodilation → ↓preload (contraindicated in RV infarction, HCM).

10. Key ECG Findings

• STEMI: ST elevation.
• Hyperkalemia: Peaked T waves → widened QRS → sine wave → VF.
• Hypokalemia: U waves, flat T waves.
Long QT Syndrome: Risk of Torsades de pointes (treat with Mg² ).
•

Nephrology

1. Acid-Base Disorders

Metabolic Acidosis (pH <7.35, HCO₃ <22)

• Anion Gap (AG) = Na – (Cl + HCO₃ ) o ↑AG (MUDPILES):

 Methanol, Uremia, DKA, Paraldehyde, INH/Iron, Lactic
acidosis, Ethylene glycol, Salicylates. o Normal AG (Hyperchloremic):
 Diarrhea, RTA (Type 1-4), acetazolamide, saline infusion.
• Treatment: Correct underlying cause (e.g., insulin for DKA, bicarb for severe acidosis).

Metabolic Alkalosis (pH >7.45, HCO₃ >26)

• Causes:
o Vomiting/NG suction (loss of H ) → hypochloremic, hypokalemic. o
Hyperaldosteronism (↑H excretion).
• Treatment: NS for volume depletion, KCl for hypokalemia, acetazolamide if volume
overloaded.

Respiratory Acidosis/Alkalosis

• Respiratory Acidosis (↑pCO₂): COPD, opioid overdose.

• Respiratory Alkalosis (↓pCO₂): Anxiety, PE, salicylate toxicity.

2. Electrolyte Disorders

Hyperkalemia (K >5.0)

• Causes: K supplements, ACEIs/ARBs, spironolactone, rhabdo, acidosis.

• ECG: Peaked T waves → widened QRS → sine wave → VF.
• Treatment:
 o Stabilize myocardium: Calcium gluconate. o Shift K into cells: Insulin +
glucose, albuterol, bicarb. o Remove K : Kayexalate, dialysis.

Hypokalemia (K <3.5)

• Causes: Diuretics, vomiting, hyperaldosteronism.

• ECG: U waves, flat T waves, arrhythmias.
• Treatment: Oral/KCl IV (if severe).

Hypernatremia (Na >145) → Water loss (diabetes insipidus, dehydration).

Hyponatremia (Na <135) → SIADH, heart failure, cirrhosis.

3. Acute Kidney Injury (AKI)

Prerenal (↓Renal perfusion)

• Causes: Hypovolemia, HF, NSAIDs, renal artery stenosis.

• Labs: BUN:Cr >20, FENa <1%, urine osmolality >500.
• Treatment: Fluids, correct underlying cause.

Intrinsic Renal

• Acute Tubular Necrosis (ATN):

o Causes: Ischemia (prolonged hypotension), nephrotoxins (aminoglycosides,
contrast).
o Labs: Muddy brown casts, FENa >2%.
• Glomerulonephritis: Hematuria, proteinuria, RBC casts.
Interstitial Nephritis: Fever, rash, eosinophilia, WBC casts (drugs: PCN, NSAIDs).

Postrenal (Obstructive)

• Causes: BPH, stones, cervical cancer.

• Diagnosis: Hydronephrosis on ultrasound.
• Treatment: Foley catheter, nephrostomy.
•

4. Chronic Kidney Disease (CKD)

• Stages: Based on GFR (Stage 5 = ESRD, GFR <15).

• Complications:
o Anemia: ↓EPO → treat with erythropoietin. o Renal osteodystrophy: ↑PTH
→ osteitis fibrosa cystica (treat with vitamin D, phosphate binders).
o Metabolic acidosis: Bicarb supplementation.
• Indications for dialysis: Uremia, hyperkalemia, acidosis, fluid overload.

5. Glomerular Diseases

Nephrotic Syndrome (Proteinuria >3.5g/day, hypoalbuminemia, edema, hyperlipidemia)

• Minimal Change Disease: Most common in kids, responds to steroids.

• Focal Segmental Glomerulosclerosis (FSGS): HIV, obesity, heroin use.
• Membranous Nephropathy: Anti-PLA2R antibodies, associated with HBV, malignancy.

Nephritic Syndrome (Hematuria, proteinuria <3.5g, HTN, oliguria)

• Post-Strep GN: 2 weeks after strep throat, subepithelial humps on EM.

• IgA Nephropathy: Hematuria after URI, mesangial IgA deposits.
• Rapidly Progressive GN (RPGN): Crescents on biopsy (Goodpasture’s, ANCA vasculitis).

6. Tubular Disorders

• Fanconi Syndrome: Proximal RTA + glycosuria, phosphaturia, aminoaciduria.

• RTA Types:
o Type 1 (Distal): Hypokalemia, urine pH >5.5 (stones, Sjögren’s).
o Type 2 (Proximal): Hypokalemia, urine pH <5.5 (Fanconi, multiple myeloma).
o Type 4 (Hypoaldosteronism): Hyperkalemia (DM, ACEIs, spironolactone).

7. Hypertension & Renal Artery Stenosis

• Renovascular HTN: Unilateral small kidney, ↑renin, bruit.

• Diagnosis: Renal artery Doppler, captopril renography.
• Treatment: Revascularization (stenting) or ACEI if bilateral.
8. Dialysis Complications

• Disequilibrium Syndrome: Headache, seizures (rapid solute shifts).

• Access Issues: AV fistula (best), graft, catheter (highest infection risk).

9. High-Yield Pharmacology

• Loop Diuretics (Furosemide): Acts at ascending loop, causes hypokalemia, ototoxicity.

• Thiazides (HCTZ): Acts at DCT, causes hypercalcemia, hypokalemia.
• Spironolactone: K -sparing (blocks aldosterone), used in ascites.

10. Key Formulas

• FENa (%) = (Urine Na × Plasma Cr) / (Plasma Na × Urine Cr) × 100 o <1% = Prerenal,
>2% = ATN.
• Anion Gap = Na – (Cl + HCO₃ ) (Normal = 8-12).
Here are some high-yield rheumatology facts for the USMLE:

1. Rheumatoid Arthritis (RA)

• Autoantibodies: RF (IgM) and anti-CCP (more specific).

• Pathology: Synovial hyperplasia → pannus formation → joint destruction.
• Extra-articular: Rheumatoid nodules, interstitial lung disease (ILD), Felty’s syndrome
(RA + splenomegaly + neutropenia), Sjögren’s syndrome (secondary).
• X-ray: Juxta-articular osteopenia, erosions, joint space narrowing.
• Treatment: DMARDs (methotrexate 1st line), TNF-α inhibitors (if refractory).

2. Systemic Lupus Erythematosus (SLE)

• Diagnosis: ANA (sensitive but not specific), anti-dsDNA (specific, correlates with
nephritis), anti-Smith (highly specific).
• Clinical: Malar rash, discoid rash, photosensitivity, arthritis, serositis
(pleuritis/pericarditis), renal disease (lupus nephritis), neuropsychiatric symptoms.
• Drug-induced lupus: Hydralazine, procainamide, isoniazid → anti-histone antibodies.

3. Seronegative Spondyloarthropathies (HLA-B27 associated)

• Ankylosing spondylitis: Sacroiliitis (X-ray: bamboo spine), uveitis, aortic regurgitation.

• Reactive arthritis: Triad (urethritis, conjunctivitis, arthritis) – "Can’t see, can’t pee, can’t
climb a tree".
• Psoriatic arthritis: DIP joint involvement, nail pitting, "sausage digits" (dactylitis).
• Enteropathic arthritis: Associated with IBD (Crohn’s/UC).

4. Gout vs. Pseudogout

• Gout: Monosodium urate crystals (negatively birefringent, needle-shaped).

o Risk factors: Male, alcohol, diuretics, high-purine diet.
o Treatment: Acute – NSAIDs/colchicine/steroids; Chronic –
allopurinol/febuxostat (↓ uric acid).
• Pseudogout: Calcium pyrophosphate (CPP) crystals (weakly positively birefringent,
rhomboid). o Associated with: Hemochromatosis, hyperparathyroidism,
hypomagnesemia.

5. Sjögren’s Syndrome
 • Autoantibodies: Anti-Ro (SS-A) and Anti-La (SS-B).
• Clinical: Dry eyes (keratoconjunctivitis sicca), dry mouth (xerostomia), parotid
enlargement, lymphoma risk.

6. Systemic Sclerosis (Scleroderma)

• Limited (CREST syndrome):

o Calcinosis, Raynaud’s, Esophageal dysmotility, Sclerodactyly, Telangiectasia.
o Autoantibody: Anti-centromere.
• Diffuse: Pulmonary fibrosis, renal crisis (malignant HTN + ↑ renin).
o Autoantibody: Anti-Scl-70 (anti-topoisomerase).

7. Polymyositis (PM) & Dermatomyositis (DM)

• Autoantibodies: Anti-Jo-1 (PM, associated with interstitial lung disease).

• Clinical: Proximal muscle weakness, elevated CK.
• DM-specific: Heliotrope rash, Gottron’s papules.
• Associated with malignancy (especially DM).

8. Vasculitides

• Giant Cell (Temporal) Arteritis:

o Symptoms: Headache, jaw claudication, vision loss (emergency – give
steroids!).
o Diagnosis: ESR/CRP ↑, temporal artery biopsy.
• Takayasu’s arteritis: "Pulseless disease", aortic arch involvement (young women).
• Granulomatosis with Polyangiitis (GPA, Wegener’s):
o c-ANCA (anti-PR3). o Triad: Necrotizing granulomas (lungs, sinuses),
glomerulonephritis.
• Microscopic Polyangiitis (MPA): p-ANCA (anti-MPO), no granulomas.
• Eosinophilic Granulomatosis with Polyangiitis (EGPA, Churg-Strauss): Asthma,
eosinophilia, p-ANCA.

9. Osteoarthritis (OA) vs. Rheumatoid Arthritis (RA)

Feature OA RA
 Joints DIP, PIP, knees, hips MCP, PIP, wrists

Symmetry Asymmetric early Symmetric

X-ray Osteophytes, joint space narrowing Erosions, juxta-articular osteopenia

Inflammatio
Minimal Synovitis, pannus
n

10. Miscellaneous

• Polymyalgia Rheumatica: Proximal muscle pain/stiffness, ↑ ESR, responds to steroids

(often coexists with giant cell arteritis).
• Behçet’s Disease: Oral/genital ulcers, uveitis, pathergy.
• Lyme Disease: Erythema migrans, knee arthritis, facial palsy (CN VII).

Key Mnemonics:

• SLE criteria (SOAP BRAIN MD) – Serositis, Oral ulcers, Arthritis, Photosensitivity, Blood
disorders, Renal, ANA, Immunologic, Neurologic, Malar rash, Discoid rash.
• CREST syndrome – Calcinosis, Raynaud’s, Esophageal dysmotility, Sclerodactyly,
Telangiectasia.

RESPIRATORY

1. Obstructive vs. Restrictive Lung Disease

 Restrictive (↓ TLC, normal/increased
Feature Obstructive (↓ FEV₁/FVC)
FEV₁/FVC)

Example COPD, Asthma,

ILD, Sarcoidosis, Kyphoscoliosis, Obesity
s Bronchiectasis

Spiromet
FEV₁/FVC < 0.7 FEV₁/FVC ≥ 0.7, ↓ TLC
ry

Causes Airway obstruction Reduced lung expansion (fibrosis, chest wall)

2. Chronic Obstructive Pulmonary Disease (COPD)

• Types:
o Chronic bronchitis ("Blue bloater") – productive cough, hypoxemia, cor
pulmonale. o Emphysema ("Pink puffer") – dyspnea, barrel chest, ↓ DLCO, α-1
antitrypsin deficiency (panacinar emphysema in young non-smokers).
• Pathology: Destruction of alveoli (emphysema) or mucus hypersecretion
(bronchitis).
• Diagnosis: Post-bronchodilator FEV₁/FVC < 0.7.
• Treatment: Smoking cessation, SABA/LAMA (bronchodilators), oxygen if hypoxemic.

3. Asthma

• Triad: Wheezing, dyspnea, cough (worse at night).

• Pathology: Reversible airway obstruction, eosinophilic inflammation.
• Diagnosis: ↑ FEV₁ after bronchodilator (≥12%), ↓ FEV₁/FVC.
• Severe attack: Silent chest, PaCO₂ > 40 mmHg (ominous sign of respiratory fatigue).
• Treatment: SABA (albuterol), ICS, leukotriene inhibitors (montelukast).

4. Pulmonary Embolism (PE)

• Wells Criteria (estimates probability):

o Clinical signs of DVT, HR > 100, recent immobilization/surgery, hemoptysis,
malignancy.
• Diagnosis: CT angiography (gold standard), D-dimer (if low probability).
 • ECG: S1Q3T3, right heart strain (RBBB, RAD, T-wave inversions V1-V4).
• Treatment: Anticoagulation (heparin → DOACs/warfarin).

5. Pneumonia

Type Key Features Causative Organisms

Communit Fever, cough, S. pneumoniae (most common), H.

y (CAP) crackles influenzae, Mycoplasma (atypical)

Hospital
>48h after admission Pseudomonas, MRSA, Klebsiella
(HAP)

Right lower lobe, Anaerobes (Bacteroides,

Aspiration
foulsmelling sputum Peptostreptococcus)

Night sweats, weight

TB Mycobacterium tuberculosis
loss, +AFB stain

• Diagnosis: CXR, sputum culture, procalcitonin (bacterial vs. viral).

• Treatment: CAP – Ceftriaxone + azithromycin; HAP –
Piperacillintazobactam/vancomycin.
6. Interstitial Lung Disease (ILD)

• Causes: Pneumoconioses (asbestosis, silicosis), drugs (amiodarone, bleomycin),

sarcoidosis, idiopathic pulmonary fibrosis (IPF).
• Findings: Bibasilar crackles, restrictive pattern, honeycombing on CT.
• Diagnosis: HRCT, lung biopsy.

7. Lung Cancer

• Non-small cell (NSCLC) (80%):

o Adenocarcinoma (peripheral, non-smokers, EGFR mutations).
o Squamous cell (central, smoking, PTHrP → hypercalcemia).
• Small cell (SCLC) (20%): Central, smoking, paraneoplastic syndromes (SIADH, Lambert-
Eaton).
• Diagnosis: CT-guided biopsy, PET scan for staging.
8. Pleural Diseases

• Pleural effusion:
o Transudate (↑ hydrostatic pressure – CHF, nephrotic syndrome).
o Exudate (↑ permeability – pneumonia, malignancy, TB) – Light’s criteria.
• Pneumothorax: o Primary (tall, thin males, ruptured blebs). o Secondary (COPD,
trauma).
o Tension pneumo (tracheal deviation, hypotension, absent breath sounds).

9. Sleep Apnea

• Obstructive (OSA): Daytime sleepiness, snoring, obesity, hypertension.

• Diagnosis: Polysomnography (PSG).
• Treatment: CPAP, weight loss.

10. High-Altitude Pulmonary Edema (HAPE)

• Symptoms: Dyspnea, cough, pink frothy sputum.

• Pathophysiology: Hypoxia → pulmonary vasoconstriction → edema.
• Treatment: Descent, oxygen, nifedipine.

Key Mnemonics:

• COPD exacerbation treatment: Steroids, Oxygen, Bronchodilators, Antibiotics (if

infective).
• Asthma drugs (quick relief vs. maintenance): SABA (rescue), ICS (prevention).
• Pneumonia bugs: CAP = S. pneumo, HAP = Pseudomonas/MRSA, Atypical =
Mycoplasma/Chlamydia

Final Tip: Focus on clinical correlations (e.g., nerve injuries, hernias, fractures) and vascular
supply patterns for exams!

Source: Dr. Maurych’s Anatomy Shelf Notes.

High-yield physiology concepts from Guyton & Hall that are
essential for USMLE/NRE:

1. Cardiovascular Physiology
• Frank-Starling Law: ↑ Preload → ↑ Stroke volume (up to a point)
• Cardiac Output (CO) = HR × SV o SV depends on preload, afterload, contractility
• Mean Arterial Pressure (MAP) = CO × TPR o Baroreceptor reflex (carotid/aortic arch)
adjusts HR and TPR
• Vascular Resistance:
o Poiseuille’s Law: Resistance 1/radius⁴ (most important regulator of blood flow)
• Coronary Blood Flow:
o Occurs mainly during diastole (LV compression blocks flow in systole)
2. Renal Physiology

• GFR = Kf × (PGC – PBS – πGC) o Autoregulation: Myogenic + Tubuloglomerular

feedback (macula densa)
• Na+ Reabsorption:
o PCT (67%) – Na+/H+ exchanger, Loop of Henle (25%) – NKCC2, DCT (5%) –
Na+/Cl– cotransporter
• Countercurrent Mechanism:
o Descending limb: Water reabsorption (via aquaporins) o Ascending limb:
Na+/K+/Cl– reabsorption (dilutes urine)
• ADH (Vasopressin): ↑ Water reabsorption in collecting duct (via aquaporin-2)
• Aldosterone: ↑ Na+ reabsorption & K+ secretion in DCT/CD

3. Respiratory Physiology

• Alveolar Gas Equation: PAO₂ = FiO₂(PATM – PH₂O) – (PaCO₂/R) o A-a Gradient = PAO₂ –
PaO₂ (↑ in V/Q mismatch, diffusion defects, R→L shunt)
• Oxygen-Hemoglobin Dissociation Curve:
o Right shift (↓ affinity): ↑ CO₂, ↑ H , ↑ 2,3-BPG, ↑ Temp (e.g., exercise) o Left
shift (↑ affinity): ↓ CO₂, ↓ H , ↓ 2,3-BPG, ↓ Temp (e.g., fetal Hb)
• Ventilation-Perfusion (V/Q) Mismatch: o Dead space (V/Q = ∞): Pulmonary embolism
o Shunt (V/Q = 0): Atelectasis, pneumonia
4. Acid-Base Balance

• Henderson-Hasselbalch Equation: pH = 6.1 + log([HCO₃ ] / (0.03 × PCO₂))

• Metabolic Acidosis: ↓ HCO₃ (e.g., DKA, diarrhea) → ↑ Anion Gap (MUDPILES) •
Respiratory Acidosis: ↑ PCO₂ (e.g., COPD, opioid OD) • Renal Compensation:
o Proximal tubule: Reabsorbs HCO₃
o Collecting duct: Secretes H (via H -ATPase)

5. Neurophysiology

• Action Potential:
o Depolarization: Na+ influx (fast channels) o Repolarization: K+ efflux (slow
channels)
o Refractory Periods: Absolute (Na+ inactivation) vs. Relative (K+ efflux)
• Synaptic Transmission:
o EPSP (Na+/Ca² influx) vs. IPSP (Cl influx/K efflux)
o NMJ: ACh → Nicotinic receptors → Na+ influx → Muscle contraction

6. Endocrine Physiology

• Hypothalamic-Pituitary Axis:
o TRH → TSH → T3/T4 (↑ BMR, ↑ β-receptors)
o CRH → ACTH → Cortisol (↑ gluconeogenesis, immunosuppression)
• Insulin vs. Glucagon:
o Insulin (β-cells): ↑ Glucose uptake (GLUT4), ↓ Lipolysis o Glucagon (α-cells): ↑
Glycogenolysis, ↑ Gluconeogenesis

7. GI Physiology

• Gastric Acid Secretion:

o Parietal cells: H /K ATPase (stimulated by ACh, gastrin, histamine) o Cephalic
phase: Vagal stimulation (ACh)
• Bile: Emulsifies fats (bile salts), excretes bilirubin (no digestion)
• Absorption Sites:
 o Iron/Calcium: Duodenum
o B12/BILE SALTS: Ileum

8. Hematology

• Hemoglobin:
o O₂ binding: Cooperative binding (sigmoidal curve) o CO Poisoning: ↑ COHb →
Left shift (↓ O₂ delivery)
• Clotting Cascade:
o Extrinsic Pathway: Tissue factor (Factor VIIa) o Intrinsic Pathway: XII → XI → IX
→X

9. Autonomic Nervous System

• Sympathetic (Fight/Flight):
o α₁: Vasoconstriction (↑ BP) o β₁: ↑ HR, ↑ Contractility
• Parasympathetic (Rest/Digest):
o M3: ↑ Secretions, ↓ HR (vagal tone)

10. Special Senses

• Vision:
o Rods: Night vision (rhodopsin) o Cones: Color vision (S/M/L opsins)
• Hearing:
o Organ of Corti: Hair cells (stereocilia bend → K+ influx)

Key Mnemonics for USMLE

• Anion Gap Metabolic Acidosis: MUDPILES (Methanol, Uremia, DKA, Paraldehyde, INH,
Lactic acidosis, Ethylene glycol, Salicylates)
• Cushing’s Triad: ↑ BP, ↓ HR, Irregular RR (sign of ↑ ICP)
• Left Shift (O₂-Hb Curve): CADET face right (CO, Acidosis, 2,3-DPG, Exercise,
Temperature)
Final Tips

• Master these equations: Nernst, Fick’s Law, Henderson-Hasselbalch.

• Focus on clinical correlations: e.g., V/Q mismatch (PE vs. pneumonia), acidbase
disorders, autonomic drug effects.

High-Yield Biochemistry Points from Lippincott Illustrated Reviews (USMLE

Focus)

1. Enzyme Kinetics & Regulation

• Michaelis-Menten Equation:
o V₀ = (Vₘₐₓ × [S]) / (K + [S]) o K = Substrate concentration at ½Vₘₐₓ (↓K = ↑
affinity).
• Inhibitors:
o Competitive: ↑ K (e.g., statins for HMG-CoA reductase). o Noncompetitive: ↓
Vₘₐₓ (e.g., cyanide for cytochrome oxidase).
o Uncompetitive: ↓ both K and Vₘₐₓ.
• Allosteric Regulation: o Feedback inhibition (e.g., CTP inhibits aspartate
transcarbamoylase).

2. Carbohydrate Metabolism

• Glycolysis:
o Rate-limiting enzyme: Phosphofructokinase-1 (PFK-1) (activated by
AMP/F2,6BP; inhibited by ATP/citrate).
o ATP Yield: 2 ATP (anaerobic), 30-32 ATP (aerobic).
• Gluconeogenesis:
o Key enzymes: Pyruvate carboxylase, PEP carboxykinase, F1,6bisphosphatase,
G6Pase.
o Fed state: Insulin ↑ glycolysis, ↓ gluconeogenesis.
• TCA Cycle:
o Rate-limiting enzyme: Isocitrate dehydrogenase (NAD → NADH). o ATP Yield:
3 NADH, 1 FADH₂, 1 GTP per cycle.

3. Lipid Metabolism
 • Fatty Acid Oxidation:
o β-Oxidation: Occurs in mitochondria; Carnitine shuttle transports FA.
o Deficiency: MCAD deficiency → hypoglycemia, ↑ dicarboxylic acids.
• Ketogenesis:
o Liver mitochondria (starvation/DKA); HMG-CoA synthase is key.
• Cholesterol Synthesis:
o HMG-CoA reductase (rate-limiting; inhibited by statins).

4. Nitrogen Metabolism

• Urea Cycle:
o Location: Liver (mitochondria + cytoplasm). o Rate-limiting enzyme: Carbamoyl
phosphate synthetase I (requires Nacetylglutamate). o Deficiency: Ornithine
transcarbamylase (OTC) → ↑ ammonia, ↑ orotic acid (X-linked).
• Amino Acid Catabolism:
o Branched-chain AAs (Leu, Ile, Val): Defects cause maple syrup urine disease. o
Phenylalanine: PKU → ↑ phenylalanine, ↓ tyrosine (treated with low-Phe diet).

5. Vitamins & Cofactors

• B1 (Thiamine):
o Deficiency: Beriberi (wet/dry), Wernicke-Korsakoff.
o Enzymes: PDH, α-KGDH, transketolase.
• B12 (Cobalamin):
o Deficiency: Megaloblastic anemia, neurological defects (↓ methionine
synthase).
• Folate:
o Deficiency: Neural tube defects, megaloblastic anemia (↓ dTMP synthesis).

6. Molecular Biology

• DNA Replication:
o Leading strand: Continuous (5’→3’).
o Lagging strand: Okazaki fragments (RNA primer needed).
• Mutations:
o Missense: Single AA change (e.g., sickle cell → Glu→Val). o Nonsense:
Premature stop codon (e.g., Duchenne muscular dystrophy).
7. Glycogen Storage Diseases

Disease Deficient Enzyme Key Feature

Von Gierke G6Pase Hepatomegaly, hypoglycemia

McArdle Muscle glycogen phosphorylase Exercise intolerance, myoglobinuria

Pompe Lysosomal α-1,4-glucosidase Cardiomegaly, infantile death

8. Metabolic Pathways Integration

• Fed State: Insulin ↑ glycolysis, FA synthesis, glycogenesis.

• Fasting State: Glucagon ↑ gluconeogenesis, glycogenolysis, ketogenesis.

9. Clinical Correlations

• G6PD Deficiency: Hemolytic anemia with oxidative stress (favism, sulfa drugs).
• Lesch-Nyhan Syndrome: HGPRT deficiency → ↑ uric acid, self-mutilation.
• Alkaptonuria: Homogentisate oxidase deficiency → black urine, ochronosis.

10. High-Yield Mnemonics

• Rate-limiting enzymes:
o Glycolysis: PFK-1 (People Fear Keto).
o TCA: Isocitrate DH (I Like TCA).
• Urea Cycle Defects: OTC (Ornithine = Only Treatable with Carbs).

Final Tips for USMLE

• Focus on diseases (e.g., glycogen storage, vitamin deficiencies).

• Master rate-limiting enzymes and their regulators.
• Link pathways to clinical scenarios (e.g., DKA → ketogenesis, PKU → tyrosine
deficiency).

High-Yield General Pathology Points from Robbins Pathology (USMLE Focus)

1. Cellular Adaptations & Injury
• Atrophy: ↓ Cell size (e.g., disuse atrophy, denervation).
• Hypertrophy: ↑ Cell size (e.g., cardiac muscle in hypertension).
• Hyperplasia: ↑ Cell number (e.g., endometrial hyperplasia, BPH).
• Metaplasia: Replacement with another cell type (e.g., Barrett’s esophagus, squamous
metaplasia in smokers).
• Reversible Injury: Cellular swelling, fatty change.
• Irreversible Injury: Necrosis (coagulative, liquefactive, caseous, fat, fibrinoid) vs.
Apoptosis (programmed cell death).

2. Inflammation & Repair

• Acute Inflammation:
o Cardinal signs: Rubor (redness), tumor (swelling), calor (heat), dolor (pain),
functio laesa (loss of function).
o Mediators: Histamine (mast cells), prostaglandins (COX pathway), bradykinin
(pain).
o Outcomes: Resolution, abscess, fibrosis, chronic inflammation.
• Chronic Inflammation:
o Cells: Macrophages, lymphocytes, plasma cells.
o Granuloma: Epithelioid macrophages + giant cells (e.g., TB, sarcoidosis).
• Wound Healing:
o Primary intention: Clean surgical incision.
o Secondary intention: Large wound (e.g., ulcer).

3. Hemodynamic Disorders

• Edema: ↑ Hydrostatic pressure (e.g., CHF) or ↓ oncotic pressure (e.g., nephrotic

syndrome).
• Thrombosis: Virchow’s triad (endothelial injury, stasis, hypercoagulability).
• Embolism:
o Pulmonary embolism: DVT → right heart → lungs.
o Paradoxical embolism: DVT → ASD/VSD → systemic circulation.
• Infarction:
o Pale infarct: Arterial occlusion (e.g., kidney, heart). o Hemorrhagic infarct:
Venous occlusion or dual blood supply (e.g., lung, liver).
4. Neoplasia

• Benign vs. Malignant:

o Benign: Well-differentiated, slow growth, no metastasis.
o Malignant: Poorly differentiated, invasion/metastasis.
• Carcinogenesis:
o Oncogenes: RAS (most common), MYC, HER2/neu.
o Tumor suppressors: p53 ("guardian of genome"), RB, APC.
• Paraneoplastic Syndromes:
o Small cell lung cancer: ACTH (Cushing’s), SIADH.
o Squamous cell carcinoma: PTHrP (hypercalcemia).

5. Genetic Disorders

• Autosomal Dominant:
o Huntington’s disease: CAG repeats → chorea, dementia.
o Familial adenomatous polyposis (FAP): APC mutation → colon polyps.
• Autosomal Recessive:
o Cystic fibrosis: ΔF508 mutation in CFTR → ↑ Cl in sweat, lung/pancreas disease.
o Phenylketonuria (PKU): Phenylalanine hydroxylase deficiency.
• X-Linked:
o Duchenne muscular dystrophy: Dystrophin deletion → ↑ CK, Gower’s sign.

6. Immunopathology

• Hypersensitivity Reactions:
o Type I (IgE): Anaphylaxis, asthma. o Type II (IgG/IgM): AIHA, Goodpasture’s
(anti-GBM). o Type III (Immune complexes): SLE, post-streptococcal GN.
o Type IV (T-cell): TB granuloma, contact dermatitis.
• Autoimmune Diseases:
o SLE: Anti-dsDNA, anti-Smith, butterfly rash.
o Rheumatoid arthritis: Anti-CCP, synovial pannus.
7. Infectious Disease Pathology

• Bacterial:
o Staph. aureus: Abscesses (coagulase +), toxic shock syndrome (TSST-1).
o Strep. pyogenes: Rheumatic fever (M protein), post-streptococcal GN.
• Viral:
o HIV: ↓ CD4 T cells → opportunistic infections (PCP, CMV, TB).
o HPV: Squamous cell carcinoma (types 16/18).

8. Environmental & Nutritional Pathology

• Smoking: Squamous metaplasia → lung cancer, emphysema (α1-antitrypsin deficiency).

• Alcohol: Fatty liver → cirrhosis, Wernicke-Korsakoff (B1 deficiency).
• Vitamin Deficiencies:
o B1 (Thiamine): Wet/dry beriberi, Wernicke-Korsakoff.
o B12: Megaloblastic anemia, subacute combined degeneration.

9. High-Yield Mnemonics

• Necrosis Types: CLF (Coagulative, Liquefactive, Fat).

• Tumor Suppressors: p53, RB, APC ("PRAy they don’t mutate").
• Granulomatous Diseases: TB, Sarcoidosis, Cat-scratch, Histoplasmosis (TSCH).

Final Tips for USMLE

• Focus on mechanisms: e.g., how p53 mutations cause Li-Fraumeni syndrome.

• Link pathology to clinical findings: e.g., caseous necrosis → TB.
• Master high-yield images: e.g., Reed-Sternberg cells (Hodgkin’s lymphoma).

High-Yield Community Medicine Points for USMLE

1. Epidemiology & Biostatistics

 • Prevalence vs. Incidence:
o Prevalence = Total cases / Total population at a given time.
o Incidence = New cases / Population at risk over a time period.
• Study Types:
o Randomized Controlled Trial (RCT) = Gold standard for causation.
o Cohort Study = Prospective, calculates relative risk (RR).
o Case-Control Study = Retrospective, calculates odds ratio (OR).
• Sensitivity & Specificity:
o Sensitivity = True positives / (True positives + False negatives).
o Specificity = True negatives / (True negatives + False positives).

2. Screening Tests

• Positive Predictive Value (PPV) = True positives / (True positives + False positives).
• Negative Predictive Value (NPV) = True negatives / (True negatives + False negatives).
• High Sensitivity Tests = Best for ruling out disease (SnOUT).
• High Specificity Tests = Best for ruling in disease (SpIN).

3. Vaccination & Immunization

• Live Attenuated Vaccines (Contraindicated in pregnancy/immunocompromised):

o MMR, Varicella, Yellow Fever, Rotavirus, Oral Polio (Sabin).
• Inactivated/Killed Vaccines:
o Influenza, Hepatitis A, Rabies, Salk Polio.
• Toxoid Vaccines:
o Tetanus, Diphtheria.
4. Infectious Disease Control

• Quarantine = Separates exposed but asymptomatic individuals.

• Isolation = Separates symptomatic infected individuals.
• R0 (Basic Reproduction Number): o R0 > 1 = Epidemic likely.
o R0 < 1 = Outbreak will die out.

5. Occupational & Environmental Health

• Lead Poisoning:
o Symptoms: Anemia, wrist drop, encephalopathy.
 o Treatment: Chelation (EDTA, Succimer).
• Asbestos Exposure: o Diseases: Mesothelioma, lung cancer, asbestosis.

6. Maternal & Child Health

• APGAR Score (Assessed at 1 & 5 min): o 0-3 = Severe distress. o 4-6 = Moderate
distress.
o 7-10 = Normal.
• Breastfeeding Benefits: o Colostrum = Rich in IgA, protects against infections.

7. Nutrition & Deficiency Disorders

• Vitamin A Deficiency: o Symptoms: Night blindness, Bitot’s spots, xerophthalmia.

• Vitamin D Deficiency: o Children: Rickets (bowing of legs). o Adults: Osteomalacia.

8. Preventive Medicine

• Primary Prevention = Prevents disease (e.g., vaccination).

• Secondary Prevention = Early detection (e.g., screening).
• Tertiary Prevention = Reduces complications (e.g., rehab).
9. High-Yield Mnemonics

• Live Vaccines: MY VRR (MMR, Varicella, Rotavirus, Rubella, Yellow Fever).

• Notifiable Diseases: Mumps, Measles, Rabies, TB, Hepatitis A/B/C.

Final Tips for USMLE

• Focus on screening tests, vaccination schedules, and R0 calculations.

• Memorize key deficiency diseases and their treatments.
• Link epidemiology to public health interventions.