usmle prep lecture series lecture 2...usmle prep lecture series lecture 2.2 elite medical prep guide...

USMLEPREPLECTURESERIES

Lecture2.2

EliteMedicalPrepGuideforTechnionStudentsfromDay1toTestday

LastUpdated:August30,2017.Delivered:August31,2017

ObjectivesSmallGroupUpdate

RoadMaptoSuccess

ChallengeQuestions

Takeaways

Followuptoquestions/issuesfollowingLecture2.1:

� WhatshouldIbedoingrightnow?

for

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Step 1 Outline

Year Two Intro Lecture

1hr Didactic USMLE Prep lectures delivered by Elite Medical Prep

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RoadmaptoStep1Success:Overview

• WhatResourcestoUse,andwhen

• HowtoAllocateStudyTime

• WhentotakeanAssessment

• StructuredApproachtotacklingQuestions/Prompt

• Highlightkeyphrasestohelp“decode”theexamlanguage

• Choosingthe“best”answerbysummarizingtoavoiddistractors

• Determinewhat’sHighYield,andwhat’snot

• Provideinsightonhowtheexamasksimportanttopics

• Pushthinkingandknowledgetothelevelofdetailrequired

• Seekadvicefromexperiencedandtrustedsources(e.g.faculty,upperclassmen,tutors)

• DiagnoseandCorrectweaknesses

• AssessExamDayreadiness

StudyStrategy

TestStrategy

Resources

Knowledge&Insight

Student

RoadmaptoStep1Success:Continued

Youareonastudyjourney…

Assesswhereyouare,andwhereyouwant

togo

Designacustomstudyplantofityourgoalsandneeds

Accesshigh-yieldcontent

Identifyareasofweaknessandaddressthem

Decodethelanguageoftheexam– whatto

lookforandpayattentionto

Settleonaprovenapproachfor

attackingprompts

Takecareofyourself– setupandseekoutsupportsystems

Assessyourprogressusingobjective

performancedata

CreateaplanandSTICKTOIT!

Resources– Maximizetheuseofafewhighqualityresources

xx

SecondyearstudentsshouldhavebothFirstAidandtheQbank,anda

pathologyresource

FirstyearstudentsshouldhaveFirstAidandtheQbank

Prim

aryRe

sources

FirstAidandtheQbank shouldcomprise>90%ofyourstudyefforts

GetthroughQbank atleast2xbeforetakingtheexam• 1st Pass:mixtureofTUTORmode&TIMEDmode• ResettheQbank• 2nd Pass:TIMEDMODE

NBMEsandUWorld SelfAssessments:2PURPOSES1. Objectiveassessmentofwhereyouare,andifyouarereadyto

sitfortheexam2. Exposesyoutoquestionpromptsfromtheactualtestwriters

Werecommendtakingnotesormaking

flashcardsonmissedquestions

Testquestionsandquestionpromptsare

frequentlyrecycledwithminoradjustments

2ndary

LimitYourResources

A 26 year old woman is brought to the emergency department by her roommate because of vomiting for 4 hours. She also has a 2 day history of fatigue and dizziness on standing. She has had severe heartburn for 3 months; treatment with over-the-counter antacids has provided some relief. The vital signs of the patient are T 35.6C (96F), pulse 110/min, and blood pressure 80/55 mm Hg. Physical examination shows marked pallor. Laboratory studies show a hemoglobin concentration of 6 g/dL and hematocrit of 18%. A chest x-ray is obtained (shown) and a pulmonary catheter is inserted and laboratory values are measured.

The patient is most likely experiencing which of the following types of shock?

A) Anaphylactic.

B) Cardiogenic.

C) Hypovolemic.

D) Neurogenic.

E) Septic.

2

3

USMLEPracticeQuestionBreakdown

1

• Thequestionstem– tellsyouwhatthequestionisasking

• Theanswerchoices– Givenyousomecontextastowhatthequestionisabout

• Theprompt– Summarizekeyinformationasit’sgiveninyourownwords;

ensurethattheanswermatchesALLoftheinformationgiven,notjustsome

• Labsandimages.EVALthelabs.IGNOREtheimages.

1

2

3

4EMP’sSUGGESTEDORDER.

Thereisnoonerightwaytodo

this.

4

ChallengeQuestionsandbreakdowns

A58yearoldfemalewitha30packyearsmokinghistorypresentstoherphysicianforacheckup.Herbloodpressureis150/90,pulse80,BMIis26.1.Serumstudiesshowhypokalemia,increasedplasmareninactivity,andincreasedserumaldosteroneconcentrations.Arightabdominalbruitisheardonphysicalexamination.PartAWhichofthefollowingisthemostlikelycauseoftheseabnormallaboratoryfindingsinthispatient?A. Aldosterone-secretingadrenaltumorB. ChronicglomerulonephritisC. CushingsyndromeD. EssentialhypertensionE. Catecholamine-secretingtumorF. RenalarterystenosisG. Cholesterolembolizationsyndrome

Recall that HTN is defined as 140/90 or greater

RAASActivationHypokalemia(↓K)+↑Renin+↑AldosteroneGeneralfxn ofkidney:keepNa+,dumpK+,H+ØAldosteronepotentiatestheseeffects

RAASactivationØLowcirc.Volume,Lowrenal perfusion

• Dehydration,bloodloss,shockØNormalcirculatingvolume,Lowrenal perfusion

• Kidneydysfunction

By A. Rad (me) - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=549506

A58yearoldfemalewitha30packyearsmokinghistorypresentstoherphysicianforacheckup.Herbloodpressureis150/90,pulse80,BMIis26.1.Serumstudiesshowhypokalemia,increasedplasmareninactivity,andincreasedserumaldosteroneconcentrations.Arightabdominalbruitisheardonphysicalexamination.PartAWhichofthefollowingisthemostlikelycauseoftheseabnormallaboratoryfindingsinthispatient?A. Aldosterone-secretingadrenaltumorB. ChronicglomerulonephritisC. CushingsyndromeD. EssentialhypertensionE. Catecholamine-secretingtumorF. RenalarterystenosisG. Cholesterolembolizationsyndrome

Pheochromocytoma Renal Artery Stenosis

Genetic, 10% in kids Athero + Smoking

Metanephrines in urine Abdominal bruit (noise)

A58yearoldfemalewitha30packyearsmokinghistorypresentstoherphysicianforacheckup.Herbloodpressureis150/90,pulse80,BMIis26.1.Serumstudiesshowhypokalemia,increasedplasmareninactivity,andincreasedserumaldosteroneconcentrations.Arightabdominalbruitisheardonphysicalexamination.PartAWhichofthefollowingisthemostlikelycauseoftheseabnormallaboratoryfindingsinthispatient?A. Aldosterone-secretingadrenaltumorB. ChronicglomerulonephritisC. CushingsyndromeD. EssentialhypertensionE. Catecholamine-secretingtumorF. Renalarterystenosis

G. Cholesterolembolizationsyndrome

Pheochromocytoma Renal Artery Stenosis

Genetic, 10% in kids Athero + Smoking

Metanephrines in urine Abdominal bruit (noise)

PartBThepatientbeginstakinganon-opioiddrugforlowerbackpain.Overthenextweek,herserumcreatinineconcentrationincreasesfrom1.5to3.5mg/dL.Catheterangiogramoftheabdominalaortaisperformed(rightsideimage).Themostlikelycauseofthisfindingisthedrug’sabilitytoinhibitwhichofthefollowing?A. InflammationintheglomerularcapillariesB. InflammationintherenalinterstitiumC. Na+/K+/2Cl- ioncotransportattheLoopofHenleD. Vasoconstricting prostaglandinsattheefferent

arterioleE. VasodilatingprostaglandinsattheafferentarterioleF. Ureareabsorptionattheproximaltubuleand

collectingduct

NSAIDS

NSAIDS

PartBThepatientbeginstakinganon-opioiddrugforlowerbackpain.Overthenextweek,herserumcreatinineconcentrationincreasesfrom1.5to3.5mg/dL.Catheterangiogramoftheabdominalaortaisperformed(rightsideimage).Themostlikelycauseofthisfindingisthedrug’sabilitytoinhibitwhichofthefollowing?A. InflammationintheglomerularcapillariesB. InflammationintherenalinterstitiumC. Na+/K+/2Cl- ioncotransportattheLoopofHenleD. Vasoconstricting prostaglandinsattheefferent

arterioleE. Vasodilatingprostaglandinsattheafferentarteriole

F. Ureareabsorptionattheproximaltubuleandcollectingduct

PartAA67yearoldwomancomestothephysicianbecauseofa1-monthhistoryoflowbackpain.Shehashypertensionwellcontrolledwithathiazidediuretic.Herpulseis140,bloodpressureis140/85mmHg.ExamshowstendernesstopalpationovertheL2-3vertebrae.SerumelectrophoresisshowsamonoclonalspikeandIgGkappa.Chestx-rayshowscardiomegalywithbilateralpleuralandpericardialeffusions.Anx-rayofthespineshowsalyticlesion.Echocardiographyshowsandechodense,thickenedleftventricleandpoordiastoliccompliance.Aphotomicrographofamyocardialbiopsyisshown.Whichofthefollowingisthemostlikelycauseofthecardiacfindinginthispatient?A. Acuteinfarction.B. Acutemyocarditis.C. Amyloidinfiltration.D. Cardiomyopathy.E. Plasmacellinfiltration

Oncology/GeneralPathQ



Ischemia

Inflammatory

Amyloid

Genetic/Intrinsic

Immune

MultipleMyelomaMalignancyofplasmacellsØ BMis>10%plasmacells(<10%isMGUS)Ø multipleorgansystems:

• Renal(nephroticsyndrome),• Cardiac(restrictiveCM,arrhythmia),• Heme (easybruising,splenomegaly)• GI(hepatomegaly)• Neuro(neuropathy).• Bone(lyticlesions&fractures)

Hyperproteinemic state2/2excessimmunecellproliferationØ ↑proteinà↑bloodviscosityà↑peripheral

resistanceStickyRBCsà stackedappearanceonhistologyà↑ESRHighLevelPointsØ assoc w/Fanconi syndromeØ proteinspikeeitherIgGorIgA

Amyloid:abnormallyfoldedproteinsà depositinvarioustissuesAllofthisisinFirstAid

NEURO:Alzheimerdiseaseduetodepositionofβ-amyloidproteincleavedfromamyloidprecursorprotein(APP)ENDO:Isletamyloidpolypeptide(IAPP)inDM2à depositionofamylininpancreaticislets.CARDIO:Atrialnatriureticpeptideà RestrictiveCM,increasedriskofatrialfibrillation.RENAL:B2microglobulin inESRDONC:Calcitonindepositionintumorcellsinmedullarycarcinomaofthethyroid



Ischemia

Inflammatory

Amyloid

Genetic/Intrinsic

Immune

PartBThepatient’sprimaryphysicianwantstoconfirmthediagnosis.Inordertobeefficientwithmedicalresourcesthephysicianwantstocarefullyconsiderwhichlaboratoryteststoorderbasedonthelikelihoodofitreturningapositiveresult.Whichofthefollowingadditionalfindingsismostlikelytobepresent?A. AntinuclearantibodiesB. Heterophile antibodiesC. Increasedleukocytealkalinephosphatase

activityD. KappalightchainproteinuriaE. Atypicallymphocyteswithplentiful

basophiliccytoplasmF. Reciprocalchromosomaltranslocations

(9;22)

Lupus

Mononucleosis

Leukemoid reaction in Neutrophils

Amyloidosis

EBV

Philadelphia chromosome CML

PartBThepatient’sprimaryphysicianwantstoconfirmthediagnosis.Inordertobeefficientwithmedicalresourcesthephysicianwantstocarefullyconsiderwhichlaboratoryteststoorderbasedonthelikelihoodofitreturningapositiveresult.Whichofthefollowingadditionalfindingsismostlikelytobepresent?A. AntinuclearantibodiesB. Heterophile antibodiesC. Increasedleukocytealkalinephosphatase

activityD. Kappalightchainproteinuria

E. Atypicallymphocyteswithplentifulbasophiliccytoplasm

F. Reciprocalchromosomaltranslocations(9;22)

Lupus

Mononucleosis

Leukemoid reaction in Neutrophils

Amyloidosis

EBV

Philadelphia chromosome CML

LeveragingQbankandFirstAidasasupplementtoregularstudying

Howyoucangetthemostoutofeveryquestion

• Practicedecodingtheanswerchoicesoneveryquestion

Milestones

Bytoday,~5monthsfromtestday

Ø Use~20-30%ormoreoftheUWorld QBankQuestions

ByendofFebruary,~4monthsfromtestday

Ø Use~50-60%ormoreofUWorld QBankQuestions

ByendofMarch,~3monthsfromtestday

Ø Use >90% ormoreofUWorld QBankQuestions

Duringat/beforeDedicatedStudyPeriod

Ø Redoall/mostofUWorld QBankQuestions

Ø IncorporateNBMEs

Ø Avoidusingnewmaterials

Can you explain to yourself why the correct answer is correct?

And why all the wronganswers are wrong?

‘Why’ismoreimportantthat‘What.’

NextStepsinourengagement

Weareavailableforfeedbackandquestions.Adedicatedemailhas

beencreatedforstudentsinyourclassyearatTechnion.

[email protected]

Pleasesendquestionsandcommentsafterthesessionstothis

email.Responseswillbepromptandquestionsrelevanttothe

groupwillbesummarizedandshared

Collectfeedbackfromyouandthestudentsregardingourservice,so

thatwemaybetterserveyouallmovingforward

ThankYou.

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