Macrocytic Anemia : How to Proceed in Investigations - Based on Kaplan USMLE Step 2 Lectures

Macrocytic Anemia : How to Proceed in Investigations - Based on Kaplan USMLE Step 2 Lectures 

B12 Deficiency

 ❖      What is the best intial test?

 S Presence of hypersegmented neutrophils and a low B12 level (NOT a Schilling test). 

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Folate Deficiency

 ❖ What is the best initial test? 

S Presence of hypersegmented neutrophils and a low folate level. 

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 Alcohol or other drug toxicity 

❖ What is the best initial test? 

S Absence of hypersegmented neutrophils and to exclude the B12 and folate deficiency and look for the drug in the history.

Clinical pearl: USMLE Step 2 and 3

When are bone scan's the correct answer on USMLE 

Step 2 & 3? 

1. Metastatic bone lesions 

2. Osteomyelitis 

3. Avascular necrosis of femoral head.

Answer: ALL 3 are correct!

Clinical Pearl in Radiology: Lytic bone lesion

Clinical Pearl in Radiology: 

When You See "Lytic bone lesion" on X-ray films, Think of . . . 

 ❖ Multiple Myeloma 

 ❖ Primary Bone Tumor

 ❖ Metastasis (most common: lung, renal, thyroid, breast)

Clinical Pearl: Hyperaldosteronism

Hypertension + Low K = Hyperaldosteronism

Clinical Pearl: Atrial Fibrillation

Clinical Pearl: Atrial Fibrillation  - "Acute Atrial Fibrillation is treated with DIRECT CARDIOVERSION if the patient is UNSTABLE. If the patient is STABLE, initial management is ventricular rate control with ARTIERIOVENTROCULAR NODAL BLOCKING AGENTS, such as digoxin, beta-blockers, diltiazem or verapamil."

Clinical Pearls Cardiology

Clinical Pearls Cardiology 

► Asymptomatic Heart Block (first degree & Mobitz I-type of 2nd degree block) = No Need to Treat

► Symptomatic Heart Block (first degree & Mobitz I) = Best initial Therapy is ATROPINE

► 2nd Degree (Mobitz II) & 3rd degree [both asymptomatic & symptomatic] = Pacemaker

Clinical Pearls in Pulmonology

Clinical Pearls in Pulmonology :

► Patients with obstructive lung disease have trouble blowing air out (reduced FEV1/FVC), whereas patients with restrictive lung disease have trouble getting air in (reduced TLC).

► The mainstay for treatment of chronic obstructive pulmonary disease exacerbations includes bronchodilators, oxygen, and glucocorticoids, as well as antibiotics if infection is suspected.

► Controlled supplemental oxygen along with positive-pressure mask ventilation (biphasic positive airway pressure) may prevent respiratory failure requiring intubation.

► Smoking cessation and supplemental oxygen to treat chronic hypoxemia are the only medical therapies shown to decrease mortality among persons with chronic obstructive pulmonary disease.

► The hallmark of restrictive lung disease is decreased lung capacities, particularly the TLC but also the FVC.

► Whereas in obstructive and restrictive lung disease, the FEV1 is decreased, the FEV1/FVC is decreased in obstructive processes and normal in restrictive processes.

Clinical Pearl : Hepatomegaly

Clinical Pearl:

Patient with Hepatomegaly plus Splenomegaly = Suspect one of these

• Cirrhosis
• 
  
• Polycythemia
• 
  
• Leukemia
• 
  
• Amyloidosis

=====!!!!!===== =====!!!!!===== =====!!!!!=====

Patient with Hepatomegaly plus Lymphadenopathy =

Suspect "Lymphoma"

Clinical Pearl: THALASSEMIA

Clinical Pearl: Microcytic Anemia + Normal Serum Iron = Diagnosis is "THALASSEMIA"

Chest Pain Clinical Pearl

Clinical Pearl: Pleuritic Chest Pain

Always think about "P"

Pneumothorax

Pneumonia

Pleurisy (Pleuritis)

Pulmonary embolism

Pericarditis

[If a disease presented to you with Pleuritic Pain, Think about P-above |MI Pain is NOT Pleuritic]

Clinical Pearl: Antibiotics for Anaerobes

Clinical Pearl: Antibiotics for Anaerobes

Above the diaphragm anaerobes = Clindamycin

Below the diaphragm anaerobes = Metronidazole

[Kaplan USMLE CK Step 2-Conrad Fischer)