USMLE PREP LECTURE SERIES Lecture 2...USMLE PREP LECTURE SERIES Lecture 2.2 Elite Medical Prep Guide...
Transcript of USMLE PREP LECTURE SERIES Lecture 2...USMLE PREP LECTURE SERIES Lecture 2.2 Elite Medical Prep Guide...
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USMLEPREPLECTURESERIES
Lecture2.2
EliteMedicalPrepGuideforTechnionStudentsfromDay1toTestday
LastUpdated:August30,2017.Delivered:August31,2017
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ObjectivesSmallGroupUpdate
RoadMaptoSuccess
ChallengeQuestions
Takeaways
Followuptoquestions/issuesfollowingLecture2.1:
� WhatshouldIbedoingrightnow?
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for
10 hoursOnline Small Group Tutoring for Step 1
Tutoring is Supplemented by Back-End Support Provided for Tutoring Students
Group Tutoring USMLE Step1 3
5 tutoring sessions x 2 hr each
Step 1 Outline
Year Two Intro Lecture
1hr Didactic USMLE Prep lectures delivered by Elite Medical Prep
2hr Intensive Online Small Group sessions offered by Elite Medical Prep
As of today, all but one student who has signed up for small group tutoring has submitted their paperwork and payment
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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
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RoadmaptoStep1Success:Continued
Youareonastudyjourney…
Assesswhereyouare,andwhereyouwant
togo
Designacustomstudyplantofityourgoalsandneeds
Accesshigh-yieldcontent
Identifyareasofweaknessandaddressthem
Decodethelanguageoftheexam– whatto
lookforandpayattentionto
Settleonaprovenapproachfor
attackingprompts
Takecareofyourself– setupandseekoutsupportsystems
Assessyourprogressusingobjective
performancedata
CreateaplanandSTICKTOIT!
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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
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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
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ChallengeQuestionsandbreakdowns
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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
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RAASActivationHypokalemia(↓K)+↑Renin+↑AldosteroneGeneralfxn ofkidney:keepNa+,dumpK+,H+ØAldosteronepotentiatestheseeffects
RAASactivationØLowcirc.Volume,Lowrenal perfusion
• Dehydration,bloodloss,shockØNormalcirculatingvolume,Lowrenal perfusion
• Kidneydysfunction
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By A. Rad (me) - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=549506
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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)
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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)
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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)
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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)
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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
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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
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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
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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
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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
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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
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Amyloid:abnormallyfoldedproteinsà depositinvarioustissuesAllofthisisinFirstAid
NEURO:Alzheimerdiseaseduetodepositionofβ-amyloidproteincleavedfromamyloidprecursorprotein(APP)ENDO:Isletamyloidpolypeptide(IAPP)inDM2à depositionofamylininpancreaticislets.CARDIO:Atrialnatriureticpeptideà RestrictiveCM,increasedriskofatrialfibrillation.RENAL:B2microglobulin inESRDONC:Calcitonindepositionintumorcellsinmedullarycarcinomaofthethyroid
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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
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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
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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
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LeveragingQbankandFirstAidasasupplementtoregularstudying
Howyoucangetthemostoutofeveryquestion
• Practicedecodingtheanswerchoicesoneveryquestion
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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
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Can you explain to yourself why the correct answer is correct?
And why all the wronganswers are wrong?
‘Why’ismoreimportantthat‘What.’
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NextStepsinourengagement
Weareavailableforfeedbackandquestions.Adedicatedemailhas
beencreatedforstudentsinyourclassyearatTechnion.
Pleasesendquestionsandcommentsafterthesessionstothis
email.Responseswillbepromptandquestionsrelevanttothe
groupwillbesummarizedandshared
Collectfeedbackfromyouandthestudentsregardingourservice,so
thatwemaybetterserveyouallmovingforward
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ThankYou.