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Buzz words

Here are the comprehensive and detailed notes from the DVT lecture transcript.

I. Introduction & Study Strategy

●​ Class Format: The session is a quick revision using buzzwords and flashcards. This method is very
famous for USMLE preparation.
●​ Relevance for Exams:
○​ NEET-PG: Focuses more on clinical questions, which can be cracked with the help of buzzwords.
○​ INI-CET: Features more factual questions.
○​ FMG: The session is very useful as a quick recap, especially for the clinical paper.
●​ Study Approach Advice:
○​ It is okay to feel overwhelmed and have backlogs. You will never be able to complete everything
because there are too many resources.
○​ The current approach should be to focus on the must-knows.
○​ Master what you are reading, even if it takes a day or two longer. You can cover up time with
shorter subjects like Ortho and Radio.
○​ You can make tweaks, such as taking extra days for a big subject like Surgery and finishing shorter
subjects faster.
○​ Do not wait to complete everything before moving to the next subject. This is especially true for
vast subjects like Medicine.
○​ You should aim to finish BTR, Bonus BTR, and PYQs (Previous Year Questions).
○​ When you feel relatively confident, you can have closure, give the test, and move on.

II. Location-Specific Buzzwords & Syndromes

A. Showering-Related Symptoms
●​ Hot showering worsening neurological symptoms:
○​ Diagnosis: Multiple Sclerosis (MS), a demyelinating disease affecting oligodendrocytes.
○​ Sign: Uhthoff's sign.
○​ Differential Diagnosis: Lhermitte's sign, which is a shock-like sensation down the spine on neck
flexion.
○​ Spinal Lesions in MS: Lesions are short-segment, meaning they span less than three vertebral
segments.
●​ Hot or cold shower worsening pruritus (itching):
○​ Diagnosis: Aquagenic Pruritus, a feature of Polycythemia Vera (PV).
○​ Pathophysiology: In PV, there is an increase in basophils (basophilia). Water contact causes
these basophils to degranulate, releasing histamine and causing pruritus.

B. Confusing Triads & Tetrads with Dermatitis

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●​ Diarrhea, Dermatitis (periorificial), Alopecia, Hypogonadism:
○​ Diagnosis: Zinc Deficiency.
○​ Dermatitis Type: Periorificial dermatitis, occurring around the mouth, genitals, and anus. The
condition is known as Acrodermatitis Enteropathica.
●​ Pancreatic Mass with Dermatitis, Diarrhea, and Diabetes:
○​ Diagnosis: Glucagonoma. The key clincher here is diabetes.
○​ Dermatitis Type: Necrolytic Migratory Erythema, which appears as a very red, non-specific,
necrotic lesion.
●​ Appendix Mass with Diarrhea, Dermatitis, and Dementia:
○​ Diagnosis: Carcinoid Syndrome leading to Pellagra (Niacin/Vitamin B3 deficiency).
○​ Pathophysiology: Pellagra occurs because Tryptophan is diverted to produce excess Serotonin
in carcinoid syndrome, leaving less for Niacin synthesis.
■​ [Mnemonic] Tryptophan gives rise to molecules with "in": Serotonin, Melatonin, and
Niacin. Do not confuse with Melanin.
○​ Dermatitis Type: Photosensitive rash, classically presenting as Casal's Necklace.

C. Anemia and Associated Conditions

●​ Infection + Megaloblastic Anemia:
○​ Diagnosis: Diphyllobothrium latum (Fish Tapeworm) infection.
○​ Pathophysiology: D. latum affects the ileum, leading to Vitamin B12 deficiency.
1.​ [Mnemonic] Iron Fist Bro: Iron is absorbed in the Duodenum, Folate in the Jejunum, and
B12 (Bro) in the Ileum.
○​ Key Features of D. latum:
1.​ It is the only cestode with two intermediate hosts (Cyclops and fish).
2.​ It is the only cestode with an operculated egg (a feature typical of trematodes).
●​ Infection + Iron Deficiency Anemia:
○​ Diagnosis: Hookworm infection, which causes chronic bleeding.
○​ [Exam Tip] In an elderly male or postmenopausal female with iron deficiency anemia and GI
symptoms, always rule out Colon Cancer, specifically right-sided colon cancer, which presents
with occult bleeding.
1.​ Left-sided colon cancer typically presents with obstruction. The most common site
overall is the rectosigmoid junction.
2.​ Most common cause of large bowel obstruction: Colon cancer.
3.​ Most common cause of small bowel obstruction: Adhesions (managed conservatively).
●​ Hemolytic Anemia + Loss of Vibration/Proprioception (Dorsal Column Signs):
○​ Diagnosis: Vitamin E Deficiency.
○​ Pathophysiology: Vitamin E is a powerful antioxidant. Its deficiency leaves RBCs vulnerable to
oxidative stress, causing hemolysis. It also mimics the neurological signs of B12 deficiency.
○​ Differential Diagnosis for Dorsal Column Involvement (SACD - Subacute Combined
Degeneration):
1.​ Vitamin B12 Deficiency (causes megaloblastic anemia, not hemolytic).
2.​ Vitamin E Deficiency (causes hemolytic anemia).
3.​ Copper Deficiency (does not cause hemolytic anemia).
●​ Sideroblastic Anemia:
○​ Associated Deficiency: Vitamin B6 Deficiency. It causes neuropathy but not spinal cord
involvement.
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D. Knuckle-Related Pathologies
●​ Knuckle Hyperpigmentation: Associated with Vitamin B12 deficiency.
●​ Knuckle Callus Formation:
○​ Sign: Russell's Sign.
○​ Diagnosis: Seen in Bulimia Nervosa due to self-induced vomiting.
●​ Knuckle Erythema (Redness):
○​ Sign: Gottron's Papules.
○​ Diagnosis: Seen in Dermatomyositis.
●​ Knuckle Dimpling ("Knuckle, Knuckle, Dimple, Dimple"):
○​ Finding: Short 3rd and 4th metacarpals.
○​ Phenotype Name: Albright's Hereditary Osteodystrophy.
○​ Associated Conditions:
1.​ Pseudohypoparathyroidism: Biochemical markers are abnormal (low Calcium, high
Phosphate, high PTH due to end-organ resistance).
2.​ Pseudopseudohypoparathyroidism: All biochemical markers are normal.

E. Mineral Deficiencies and Bone Pain

●​ Cardiomyopathy + Mineral Deficiency:
○​ Diagnosis: Keshan's Disease, caused by Selenium deficiency.
○​ Associated Fact: Selenocysteine is the 21st amino acid, formed via co-translational
modification.
●​ Bone Pain, Hearing Loss, Raised ALP (Alkaline Phosphatase):
○​ Diagnosis: Paget's Disease of Bone.
○​ Pathophysiology: Disorganized bone remodeling leads to bone thickening, which can compress
cranial foramina, causing hearing loss and optic nerve compression.
○​ [Exam Tip] High ALP translates to a hot spot on a bone scan. Paget's disease will show a hot
spot.
●​ Bone Pain, Normal ALP, Cold Spot on Bone Scan:
○​ Diagnosis: Multiple Myeloma.
○​ Pathophysiology: The lesions are purely lytic, caused by plasma cell proliferation, with no reactive
bone formation (osteoblastic activity). Since ALP is a marker of bone formation, it remains normal.
○​ Imaging: A bone scan (using Technetium-99m MDP/methylene diphosphonate) will show a
cold spot because there is no new bone turnover.
●​ Raised ALP, Xanthelasma, and Pruritus:
○​ Diagnosis: Primary Biliary Cholangitis (PBC). The raised ALP is of biliary, not bony, origin.
○​ Confirmatory Test: Anti-Mitochondrial Antibody (AMA).
○​ Histopathology: Florid duct lesions with granulomas.
○​ Differential Diagnosis: Primary Sclerosing Cholangitis (PSC), which is associated with
Ulcerative Colitis, p-ANCA positive, and shows onion-skinning on histopathology.

III. Organ-Specific Pathologies & Syndromes

A. Jaundice & Liver Syndromes
●​ Isolated Unconjugated Bilirubinemia (only with stress/fever):
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○​ Diagnosis: Gilbert's Syndrome.
●​ Severe Neonatal Jaundice with Kernicterus (Unconjugated):
○​ Diagnosis: Crigler-Najjar Syndrome.
●​ Isolated Conjugated Bilirubinemia:
○​ Differential Diagnoses: Dubin-Johnson Syndrome and Rotor Syndrome.
○​ Distinguishing Feature: Dubin-Johnson has a black liver.
■​ [Mnemonic] DJ Bravo is black -> Dubin-Johnson has a black liver.
■​ The black color is due to epinephrine metabolites, not bilirubin.

B. Osteomyelitis Causes
●​ Foot wound puncture (e.g., stepping on a nail): Pseudomonas aeruginosa.
●​ Sickle Cell Patient: Salmonella.
○​ Other Pseudomonas Associations:
■​ Hot tub folliculitis.
■​ Most common infection in burns.
■​ Contact lens keratitis (differential is Acanthamoeba).
■​ Malignant Otitis Externa.
■​ Swimmer's Ear (Generalized Otitis Externa).
■​ Surfer's Ear is different; it refers to bony growths (exostoses).

C. Aplastic Crisis & Pure Red Cell Aplasia (PRCA)

●​ Aplastic Crisis in a Sickle Cell patient (or any patient):
○​ Causative Agent: Parvovirus B19.
●​ Causes of Pure Red Cell Aplasia (PRCA):
○​ Parvovirus B19 infection.
○​ Thymoma (as a paraneoplastic syndrome).
○​ Diamond-Blackfan Anemia.
●​ Other Paraneoplastic Syndromes of Thymoma:
○​ Myasthenia Gravis.
○​ Good's Syndrome (Hypogammaglobulinemia).

D. Myasthenic Syndromes
●​ Myasthenia Gravis (MG):
○​ Weakness worsens towards the end of the day.
○​ Defect in postsynaptic acetylcholine receptors.
○​ Repetitive nerve stimulation shows a decremental response.
●​ Lambert-Eaton Myasthenic Syndrome (LEMS):
○​ Defect in presynaptic calcium channels.
○​ Repetitive nerve stimulation shows an incremental response.
○​ Associated Paraneoplastic Syndrome: Small Cell Lung Cancer.
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E. MYC Gene Amplifications
●​ L-myc: Lung Cancer (Small Cell).
●​ N-myc: Neuroblastoma.
●​ C-myc: Buckitt's Lymphoma.

F. Renal Mass Syndromes

●​ Sickle Cell Trait + Renal Mass: Medullary RCC.
●​ Renal Mass + Hypertension + Palpitations (Pheochromocytoma) + Cerebellar Hemangioblastoma:
○​ Diagnosis: Von Hippel-Lindau (VHL) Syndrome.
○​ Associated Tumors: Clear Cell RCC, Pheochromocytoma, Retinal/Spinal Hemangioblastomas.
○​ Genetics: Chromosome 3p deletion.
●​ Renal Mass + Pneumothorax + Follicular Skin Lesions:
○​ Diagnosis: Birt-Hogg-Dubé Syndrome.
○​ Associated Tumors: Oncocytoma or Chromophobe RCC. The pneumothorax is due to
associated lung cysts.
○​ Histopathology: Plant-like cells, resinoid nucleus. Stains with Hale's colloidal iron stain.
●​ Renal Mass + Retroperitoneal Bleed:
○​ Tumor: Angiomyolipoma (a hamartoma of vessels, muscle, fat).
○​ Syndrome Name: Wunderlich Syndrome (spontaneous retroperitoneal bleed).
○​ Associated Condition: Tuberous Sclerosis.

G. Gastric Hyperplasia Syndromes

●​ Cerebriform stomach (giant rugal folds) + Foveolar Hyperplasia:
○​ Diagnosis: Ménétrier's Disease.
○​ Pathophysiology: Overproduction of TGF-alpha.
●​ Parietal Cell Hyperplasia:
○​ Diagnosis: Gastrinoma (Zollinger-Ellison Syndrome).
○​ Pathophysiology: Excess gastrin stimulates parietal cell growth.

H. Hepatitis Enzyme Patterns

●​ AST > ALT (ratio > 2:1) and levels do not cross 300 IU/L:
○​ Diagnosis: Alcoholic Hepatitis.
○​ [Mnemonic] You raise a toast of alcohol -> AST > ALT.
○​ Most Specific Marker: Raised GGT.
●​ ALT > AST and levels are in the thousands:
○​ Diagnosis: Viral Hepatitis.

I. Abdominal Pain Syndromes

●​ Severe abdominal pain out of proportion to physical exam findings:
○​ Diagnosis: Acute Mesenteric Ischemia.
○​ Associated History: Irregularly irregular pulse (Atrial Fibrillation), which can cause an embolus.
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J. Pediatric Neurodevelopmental Syndromes
●​ 6-month-old girl with regression of milestones, microcephaly, and hand-wringing movements:
○​ Diagnosis: Rett Syndrome.
○​ Genetics: X-linked dominant, mutation in the MECP2 gene.
○​ Drug of Choice: Trofinetide.
●​ [Mnemonic] RAVI for X-linked Dominant diseases:
○​ R: Rett Syndrome.
○​ A: Alport Syndrome.
■​ Triad: Sensoryneural hearing loss, anterior lenticonus, glomerulonephritis (hematuria).
■​ Defect: Collagen IV, alpha-5 chain.
■​ Differential: Posterior lenticonus is seen in Lowe Syndrome (Oculocerebrorenal
syndrome).
○​ V: Vitamin D resistant rickets (Hypophosphatemic rickets).
○​ I: Incontinenti Pigmenti.
■​ Lesions follow Blaschko lines (embryological).
■​ [Mnemonic] B for Baby, B for Blaschko lines.
■​ Langer lines are different; they are used for surgical incisions.

IV. Pancytopenia & Hematological Syndromes

●​ Pancytopenia, Café-au-lait macules, Absent radii/thumbs:
○​ Diagnosis: Fanconi Anemia. (Do not confuse with Fanconi Syndrome of the kidney).
●​ Café-au-lait macules + Precocious puberty + Polyostotic fibrous dysplasia:
○​ Diagnosis: McCune-Albright Syndrome.
●​ Café-au-lait macules + Lisch nodules (iris hamartomas) + Neurofibromas:
○​ Diagnosis: Neurofibromatosis Type 1 (NF1).
●​ Conditions with Radial Ray Defects (Absent Radius):
○​ Fanconi Anemia.
○​ VACTERL association (Vertebral, Anal, Cardiac, Tracheo-esophageal, Renal, Limb).
○​ Holt-Oram Syndrome (associated with ASD).
○​ TAR Syndrome (Thrombocytopenia with Absent Radius).
●​ Pancytopenia + Pancreatic Insufficiency:
○​ Diagnosis: Shwachman-Diamond Syndrome.
●​ Pure Red Cell Aplasia (only RBC lineage affected):
○​ Diagnosis: Diamond-Blackfan Anemia.

V. Pituitary & Adrenal Disorders

A. Pituitary Disorders
●​ Failure to lactate post-delivery, amenorrhea, lethargy (especially with PPH history):
○​ Diagnosis: Sheehan's Syndrome (postpartum hypopituitarism).
○​ Pathophysiology: Ischemic necrosis of the pituitary, leading to an empty sella.
●​ Sudden severe headache, shock, hypopituitarism:
○​ Diagnosis: Pituitary Apoplexy.
○​ Pathophysiology: Bleeding into a pre-existing pituitary adenoma.
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●​ Galactorrhea, Amenorrhea, Bitemporal Hemianopia:
○​ Diagnosis: Prolactinoma.
○​ Pathophysiology: High prolactin inhibits GnRH, causing amenorrhea.
○​ Treatment: Cabergoline (Dopamine agonist). Bromocriptine can be used in pregnancy. Surgery is
for visual field defects.
●​ Increased Heel Pad Thickness, Coarse Facies:
○​ Diagnosis: Acromegaly.
○​ Screening Test: IGF-1 levels.
○​ Confirmatory Test: Oral Glucose Tolerance Test (OGTT); failure of glucose to suppress GH
confirms the diagnosis.

B. Adrenal Disorders
●​ Hyponatremia, Hyperkalemia, Ambiguous Genitalia (in females), High 17-OH Progesterone:
○​ Diagnosis: Congenital Adrenal Hyperplasia (CAH), specifically 21-Hydroxylase Deficiency.
○​ [Mnemonic] CAH Enzyme Trick: For enzyme deficiencies (21, 11, 17), if the number has a '1' (21,
11), testosterone is high. If it does not (17), testosterone is low. Mineralocorticoids are the
opposite.
●​ Hyponatremia, Hyperkalemia, New skin pigmentation:
○​ Diagnosis: Addison's Disease (Primary Adrenal Insufficiency).
○​ Pathophysiology: Pigmentation occurs because low cortisol leads to high ACTH production from
the POMC precursor, which also yields MSH.
●​ History of adrenalectomy for Cushing's, followed by hyperpigmentation and pituitary adenoma
growth:
○​ Diagnosis: Nelson's Syndrome.
●​ Adrenal insufficiency + Fever + Neck Rigidity (Meningitis signs):
○​ Diagnosis: Waterhouse-Friderichsen Syndrome (adrenal hemorrhage due to
meningococcemia).

VI. Metabolic & Endocrine Buzzwords

●​ Severe hypoglycemia with NORMAL C-peptide:
○​ Cause: Exogenous insulin overdose. (C-peptide is cleaved from pro-insulin, so it's only high
when the body makes its own insulin).
●​ Severe hypoglycemia with RAISED C-peptide:
○​ Causes:
1.​ Insulinoma (tumor producing insulin).
2.​ Sulfonylurea abuse (drugs that stimulate insulin secretion).
●​ Hypertension, Bradycardia, Abnormal Respiration:
○​ Diagnosis: Cushing's Triad, indicating raised intracranial pressure (ICP).
●​ Hypotension and Bradycardia:
○​ Diagnosis: Neurogenic Shock. Everything is low.
●​ High Potassium, High Phosphate, High Uric Acid, LOW Calcium (post-chemotherapy):
○​ Diagnosis: Tumor Lysis Syndrome.
●​ Low Potassium, Low Phosphate, Low Magnesium (after nutritional support in a starved patient):
○​ Diagnosis: Refeeding Syndrome.
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VII. Chest Trauma & Embolism Syndromes
●​ Chest Trauma + Absent breath sounds + Dullness to percussion + Flat neck veins (Hypovolemic
shock):
○​ Diagnosis: Hemothorax.
●​ Chest Trauma + Absent breath sounds + Hyper-resonant to percussion + Distended neck veins
(Obstructive shock):
○​ Diagnosis: Tension Pneumothorax.
●​ Long bone fracture + Triad of (Respiratory distress, Petechiae, Confusion):
○​ Diagnosis: Fat Embolism Syndrome. Fat globules can be seen in urine or retinal vessels.
●​ Sudden collapse and respiratory distress in a postpartum female (other causes ruled out):
○​ Diagnosis: Amniotic Fluid Embolism.
●​ Patient undergoing seated craniotomy + Sudden drop in ETCO2:
○​ Diagnosis: Venous Air Embolism.
○​ Immediate Management: Place the patient in the Durant position (Trendelenburg + Left Lateral
Decubitus) to trap air in the right atrium, followed by aspiration via a central line.

VIII. Renal Tubular Acidosis (RTA)

●​ Normal Anion Gap Metabolic Acidosis + High urinary pH + Nephrocalcinosis:
○​ Diagnosis: Type 1 (Distal) RTA.
○​ Causes: Amphotericin B, autoimmune diseases (e.g., Sjögren's).
●​ Normal Anion Gap Metabolic Acidosis + Rickets + Glycosuria:
○​ Diagnosis: Type 2 (Proximal) RTA, also known as Fanconi Syndrome.
○​ Pathophysiology: Defective proximal convoluted tubule reabsorption of bicarbonate, glucose,
phosphate, etc.

IX. Arthritis & Connective Tissue Disorders

●​ Gout, Self-mutilation, Choreoathetosis:
○​ Diagnosis: Lesch-Nyhan Syndrome (HGPRT deficiency, leading to hyperuricemia).
●​ Joint Arthritis with Rhomboid-shaped, positively birefringent crystals:
○​ Diagnosis: Pseudogout (Calcium Pyrophosphate Deposition - CPPD).
○​ Note: Uric acid crystals in urine are also rhomboid-shaped, but in the joint, they are
needle-shaped and negatively birefringent (gout).
●​ Arthritis, Conjunctivitis, Urethritis ("Can't see, can't pee, can't climb a tree"):
○​ Diagnosis: Reiter's Syndrome (Reactive Arthritis), often follows infections like Shigella or
Campylobacter.
●​ Migratory Polyarthritis and Skin Rash in a young female:
○​ Diagnosis: Systemic Lupus Erythematosus (SLE).
●​ Multiple fractures, Blue sclera, Conductive hearing loss, Dentinogenesis imperfecta:
○​ Diagnosis: Osteogenesis Imperfecta (Collagen Type 1 defect).
○​ Hearing loss is due to Otosclerosis. The combination is called Van der Hoeve syndrome.
○​ Fracture type: Diaphyseal fractures with lots of callus.
○​ Differential: Battered Baby Syndrome (Non-accidental injury) presents with metaphyseal
corner fractures, retinal bleeds, and subdural hemorrhage.
●​ Elastic skin, Hypermobility, Bleeding tendency:
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○​ Diagnosis: Ehlers-Danlos Syndrome (most common type is Collagen Type 5 defect; lethal
vascular type is Collagen Type 3 defect).
●​ Tall stature, Arachnodactyly, Upward lens dislocation (superotemporal), Aortic root dilation:
○​ Diagnosis: Marfan Syndrome (Fibrillin-1 defect).
●​ Marfanoid habitus, Developmental delay, Downward lens dislocation (inferomedial), Thrombosis:
○​ Diagnosis: Homocystinuria. Can be caused by B6, B9, or B12 deficiency.

X. Muscular Dystrophies & Trisomies

●​ Calf pseudohypertrophy, Gower's sign, severe progression:
○​ Diagnosis: Duchenne Muscular Dystrophy (DMD).
○​ Mutation: Deletion of the dystrophin gene.
●​ Slower, less severe progression than DMD:
○​ Diagnosis: Becker Muscular Dystrophy (BMD).
○​ Mutation: Frameshift mutation of the dystrophin gene.
●​ Microcephaly, Cleft lip/palate, Polydactyly, Cutis aplasia:
○​ Diagnosis: Patau Syndrome (Trisomy 13).
○​ Teratogenic Drug Mimic: Carbamazepine/Methimazole.
●​ Microcephaly, Rocker-bottom feet, Clenched hands:
○​ Diagnosis: Edwards Syndrome (Trisomy 18).
●​ Single palmar crease, Sandal gap, Duodenal atresia, Brushfield spots:
○​ Diagnosis: Down Syndrome (Trisomy 21).
●​ High-pitched, cat-like cry, microcephaly:
○​ Diagnosis: Cri-du-chat Syndrome (Deletion on chromosome 5p).

XI. Infectious Disease Buzzwords

●​ Fever, Vomiting, Diarrhea, Rash, Hypotension (with history of nasal packing or tampon use):
○​ Diagnosis: Toxic Shock Syndrome (caused by Staph/Strep superantigens).
●​ Colon Cancer + Infective Endocarditis:
○​ Organism: Streptococcus bovis / Streptococcus gallolyticus.
○​ [Mnemonic] BOvis in the BOwel (Colon).
●​ Bull's neck appearance, pseudomembrane on tonsils:
○​ Diagnosis: Diphtheria.
○​ Toxin Mechanism: Inhibits Elongation Factor-2 (EF-2), same as Pseudomonas exotoxin A.
○​ Stain: Albert stain (shows green bacteria with blue poles).
○​ Histopathology: Chinese letter arrangement, also seen in Fibrous Dysplasia.
●​ Red "currant jelly" sputum in a diabetic or alcoholic patient:
○​ Organism: Klebsiella pneumoniae.
○​ X-ray Finding: Bulging fissure sign.
●​ Red "currant jelly" stool:
○​ Painless: Meckel's Diverticulum.
○​ Painful (with colicky pain): Intussusception.
●​ Large "bull's-eye" rash in a hiker:
○​ Diagnosis: Lyme Disease.
○​ Rash Name: Erythema Migrans.
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○​ Differential Rashes:
■​ Erythema Marginatum: Acute Rheumatic Fever.
■​ Erythema Multiforme (target lesions): Herpes Simplex, Mycoplasma.

XII. Miscellaneous High-Yield Buzzwords

●​ Acute Kidney Injury (AKI) with FeNa < 1%:
○​ Diagnosis: Pre-renal AKI. (The tubules are working fine and are avidly reabsorbing sodium).
●​ Reduced C4 and C1-esterase inhibitor levels:
○​ Diagnosis: Hereditary Angioedema.
○​ Contraindicated Drug: ACE inhibitors.

Practice Questions and Case Studies

●​ Case Scenario 1:
○​ Question: Which of the following investigations will be done in a patient who has absent radii and
thumbs, except?
○​ Options:
1.​ Total leukocyte count
2.​ Platelet level
3.​ Echocardiogram (Echo)
4.​ Karyotyping
○​ Answer Explanation: An investigation for absent radii/thumbs should cover the differential
diagnoses: Fanconi Anemia (pancytopenia, so TLC and platelets are needed), Holt-Oram
(cardiac defects, so Echo is needed), TAR syndrome (thrombocytopenia, so platelet count is
needed), and VACTERL. Karyotyping is not a primary investigation for this specific finding.

Here are the comprehensive notes from the lecture, formatted as requested.

Pharmacology
●​ Hereditary Angioedema
○​ In hereditary angioedema, ACE inhibitors are contraindicated.
○​ The drug of choice is Danasol. This is one of the only conditions where Danasol has a role.
○​ [Exam Tip] Danasol has no role in OBG; if it appears as an option, it is likely an answer of
exclusion.

Differential Diagnosis: Cystic Fibrosis vs. Kartagener Syndrome

●​ Clinical Presentation Overlap
○​ Both conditions can present with bronchiectasis, sinusitis, and infertility.
●​ The Clincher for Diagnosis
○​ The presence of situs inversus points towards Kartagener syndrome.
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○​ [Exam Tip] Always look for the mention of situs inversus to differentiate between Kartagener
syndrome and Cystic Fibrosis.
○​ If situs inversus is not mentioned, the diagnosis is more likely Cystic Fibrosis.
●​ Kartagener Syndrome
○​ Also known as Primary Ciliary Dyskinesia (PCD).
○​ The underlying defect is immotile cilia.
○​ Infertility Mechanism:
■​ In females, the cilia in the fallopian tubes do not move the egg.
■​ In males, the sperm do not move.
●​ Cystic Fibrosis (CF)
○​ The underlying defect is in the CFTR gene on chromosome 7.
■​ Note: A correction was made from chromosome 6 (mentioned in a PDF) to the correct
chromosome 7.
○​ The most common mutation is delta F508, a deletion of phenylalanine at position 508.
○​ This is a class 2 trafficking mutation.
○​ Pathophysiology of Secretions:
■​ The CFTR chloride channel transport decreases everywhere.
■​ In sweat glands, the channels normally function to reabsorb sodium chloride. In CF, they
are unable to reabsorb, leading to salty sweat (increased sodium chloride concentration).
■​ In all other glands (respiratory, biliary, pancreatic, cervical), the channels normally secrete
sodium chloride, and water follows. In CF, they are unable to secrete, so water does not
follow, and the mucus becomes very hard and thick, leading to tubular obstruction.
■​ [Exam Tip]
■​ Concentration: Sodium chloride concentration increases in sweat but
decreases everywhere else (in the ducts).
■​ Transport: Sodium chloride transport is decreased everywhere because the
channel is not working.
○​ Infertility Mechanism:
■​ In females, infertility is due to thick cervical mucus.
■​ In males, infertility is due to congenital bilateral absence of the vas deferens. This is a
frequently asked question.
●​ Young Syndrome
○​ A variant of ciliary dyskinesia.
○​ Presents with bronchiectasis but does not have situs inversus.
○​ It is a differential diagnosis for bronchiectasis.

Gastroenterology
●​ Intussusception in Children
○​ First Investigation: Ultrasound.
○​ Investigation of Choice / Gold Standard: Barium enema.
○​ [Exam Tip] Barium enema is the investigation of choice because it is also therapeutic. Although
used rarely these days for other conditions, it remains the answer for intussusception.

Inborn Errors of Metabolism

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●​ Phenylketonuria (PKU)
○​ Buzzwords: Musty body odor, hypopigmentation, eczema.
○​ Pathophysiology: The conversion of Phenylalanine to Tyrosine is blocked.
○​ Hypopigmentation Mechanism: Without tyrosine, melanin cannot be produced.
○​ Clinical Pearl: Tyrosine becomes an essential amino acid in PKU.
○​ Neurotransmitter Effect: Since tyrosine is a precursor for dopamine, dopamine levels will
decrease. This is analogous to Parkinson's disease, where lack of dopamine leads to a lack of
melanin in the substantia nigra, causing it to appear pale instead of black.
●​ Alkaptonuria
○​ Enzyme Deficiency: Homogentisate oxidase.
○​ Buzzwords: Black urine on standing, ochronosis.
○​ Radiological Finding: IV disc calcification.
●​ Fluorosis
○​ Specific Buzzword: Interosseous membrane ossification.
●​ Pompe Disease
○​ Buzzwords: Cardiomyopathy, hepatomegaly, hypotonia (not hyperglycemia).
○​ It is both a glycogen storage disorder and a lysosomal storage disorder.
○​ Enzyme Deficiency: Acid alpha-glucosidase (also known as acid maltase).
●​ McArdle Disease
○​ Buzzword: Chronic exercise intolerance.
○​ Enzyme Deficiency: Muscle glycogen phosphorylase. Only muscle is affected.
●​ Gaucher Disease
○​ Buzzwords: Hepatosplenomegaly, pancytopenia, avascular necrosis (AVN) of the femoral
head.
○​ Hepatosplenomegaly occurs due to extramedullary hematopoiesis.
○​ Radiological Finding: Erlenmeyer flask deformity (widening of bones).
○​ Histology: Tissue paper macrophage.

Lipid and Vascular Disorders

●​ Hyperlipoproteinemia
○​ Achilles tendon xanthoma: Seen in Type II hyperlipoproteinemia.
■​ [Mnemonic] You have two Achilles tendons, so Type II.
○​ Palmar xanthoma: Seen in Type III hyperlipoproteinemia (remnant removal disease).
■​ [Mnemonic] Beggars beg from the palm, and we give them remnants. The remnant
particle is Apo E. E looks like the number 3.
●​ CEAP Classification for Chronic Venous Insufficiency
○​ [Mnemonic] The letter 'E' is the third letter in CEAP, and E looks like 3.
○​ C1: Telangiectasias.
○​ C2: Varicose veins.
○​ C3: Edema ('E' is like '3').
○​ C4: Skin changes. The names get bigger.
■​ C4a: Eczema, itchiness.
■​ C4b: Lipodermatosclerosis (a bigger name).
■​ C4c: Corona phlebectatica (biggest name, 'C' for Corona).
○​ C5: Healed ulcer.
○​ C6: Active ulcer.
 13
Neurology
●​ Differential Diagnosis: Wernicke's Encephalopathy vs. Miller-Fisher Syndrome
○​ Wernicke's Encephalopathy (Thiamine B1 Deficiency)
■​ GOA Triad: Confusion, Ophthalmoplegia, Ataxia.
○​ Miller-Fisher Syndrome (Variant of Guillain-Barré Syndrome)
■​ Triad: Ophthalmoplegia, Ataxia, and Areflexia.
■​ [Exam Tip] There is no confusion or cerebral involvement in Miller-Fisher.
■​ Hallmark Antibody: Anti-GQ1b.
●​ Amyotrophic Lateral Sclerosis (ALS)
○​ Presents with a mix of spastic (UMN) plus flaccid (LMN) signs.
●​ Poliomyelitis
○​ Key feature is asymmetric flaccid paralysis due to involvement of the anterior horn cell.

Pulmonology
●​ Asbestosis
○​ Buzzword: Frozen hemithorax.
○​ Associated with mesothelioma.
○​ Textual Description of CT Scan: Shows a unilateral, nodular pleural thickening. The drawing
shows a cross-section of the chest with the right-sided pleura thickened and nodular, with the
mediastinum and left lung appearing normal. There is no mediastinal shift.
●​ Silicosis and Coal Worker's Pneumoconiosis
○​ Buzzwords: Occupational worker with fibrotic upper lobe masses.
○​ This is called Progressive Massive Fibrosis (PMF), which appears as tumor-like masses that are
actually fibrosis.
●​ Guillain-Barré Syndrome (GBS)
○​ CSF Finding: Albuminocytological dissociation.
■​ This means albumin is high, but the cell count is normal.
■​ [Mnemonic] Whatever comes first in the name is high (albumin is high).
○​ Associated Infection: Campylobacter.
●​ Multiple Sclerosis (MS)
○​ CSF Finding: Oligoclonal bands.
○​ [Exam Tip] Do not confuse the CSF findings of GBS and MS.

Hepatology & Nephrology

●​ Spontaneous Bacterial Peritonitis (SBP)
○​ Diagnostic Criteria: Ascitic fluid with more than 250 cells.
○​ Clinical Context: A patient with long-standing ascites (e.g., a child with nephrotic syndrome or an
adult with alcoholic cirrhosis).
○​ Most Common Cause: E. coli.
○​ Drug of Choice: Ceftriaxone or any cephalosporin.
●​ Serum-Ascites Albumin Gradient (SAAG)
○​ [Exam Tip] The higher the SAAG, the higher the portal pressure.
○​ A SAAG > 1.1 indicates high portal pressure, suggesting cirrhosis due to portal hypertension.
●​ Hemolytic Uremic Syndrome (HUS)
 14
○​ Associated with EHEC (Shiga-like toxin) infection. Presents with uremia and anemia.

Cardiology
●​ JVP Waveforms
○​ Constrictive Pericarditis: Steep X and Y descents.
○​ Cardiac Tamponade: Steep X descent with a blunt or absent Y descent.
■​ [Mnemonic] TAX: Tamponade has a steep X.
●​ High-Output Heart Failure
○​ Clinical Context: Seen in patients with a history of alcohol use and malnutrition.
○​ Cause: Thiamine (B1) deficiency, specifically Wet Beriberi.
■​ Dry Beriberi is just neuropathy.

Rheumatology & Immunology

●​ Rheumatoid Arthritis (RA)
○​ Most Common Ophthalmologic Manifestation: Keratoconjunctivitis sicca (dryness) or
Sjögren's syndrome.
○​ [Exam Tip] RA is the exception. For almost all other connective tissue disorders (Ankylosing
Spondylitis, SLE, JIA), the manifestation is uveitis. RA can also cause scleritis and episcleritis.
●​ Diabetic Adhesive Capsulitis
○​ Buzzword: Frozen shoulder is seen in diabetics.

Infectious Diseases - Ulcers

●​ Intestinal Ulcers
○​ Longitudinal ulcers: Typhoid.
■​ [Mnemonic] A tie is worn longitudinally on the chest.
○​ Transverse ulcers: Tuberculosis (TB).
■​ [Exam Tip] Don't use the 'T for Transverse, T for TB' mnemonic alone, as Typhoid also
starts with T.
○​ Flask-shaped ulcers: Amoebic dysentery.
○​ Serpiginous ulcers: Crohn's disease. It starts as an aphthous ulcer and then merges.
■​ CMV can also cause serpiginous ulcers elsewhere, not necessarily in the intestine.
○​ Volcano-like (punched out) ulcers: Herpes Simplex Virus (HSV).
■​ HSV ulcers are deep but small.
■​ CMV ulcers are superficial but long.

Nutritional Deficiencies
●​ Burning Feet Syndrome
○​ Cause: Pantothenic acid (Vitamin B5) deficiency.
○​ The lecturer refers to a drawing of a burning foot wearing pants (pantothenic acid).
 15
●​ Erythromelalgia
○​ Seen in Polycythemia Vera and Essential Thrombocythemia.
○​ Pathophysiology involves neuropathy due to thrombosis from too many RBCs or platelets.

Oncology & Polyps

●​ Peutz-Jeghers Syndrome
○​ Polyp Type: Hamartomatous polyp.
○​ Microscopy: Arborizing polyp, where muscles go here and there.
○​ Gene: STK11 or LKB1.
■​ [Mnemonic] An 11-year-old (STK11) has Peutz-Jeghers.

Immunodeficiency Disorders
●​ Bruton's Agammaglobulinemia
○​ Buzzwords: Male child, onset after 6 months of age.
○​ Maternal immunoglobulins protect the boy for the first 6 months.
●​ Selective IgA Deficiency
○​ Buzzword: Anaphylaxis following blood transfusion.
○​ It is the most common immunodeficiency.
○​ Associated Infection: Giardiasis.
■​ The lecturer describes Giardia: two eyes, four anterior and four posterior flagella. Compares
to Trichomonas aunty: one eye, five flagella, only trophozoite form.
●​ Hyper-IgE Syndrome (Job Syndrome)
○​ Buzzwords: Recurrent cold abscesses, eczema, and high IgE.
○​ Other features: Supernumerary (baby) teeth.
○​ [Mnemonic] FATE: Facies (coarse), Abscesses (cold), Teeth (retained primary), Eczema, high
IgE.
●​ Chronic Granulomatous Disease (CGD)
○​ Buzzword: Recurrent infections with catalase-positive organisms and granuloma formation.
○​ Defect: NADPH oxidase.
○​ Tests: Nitroblue tetrazolium (NBT) test (older) and Dihydrorhodamine (DHR) test (favored
now).
○​ Catalase-Positive Organisms:
■​ [Mnemonic] SPACE:
■​ S: Staph
■​ P: Pseudomonas
■​ A: Aspergillus, Candida, Cryptococcus (Fungi)
■​ C: Serratia
■​ E: Enterobacter (includes E. coli).
■​ [Exam Tip] Enterococci are catalase-negative (family of Streptococci).
■​ Staph, Serratia, and Pseudomonas are also linked by pigment production.
●​ Leukocyte Adhesion Defect (LAD)
○​ Buzzwords: Late separation of the umbilical cord, no pus formation in infections.
○​ Pathophysiology: Leukocytes cannot adhere and reach the site of infection.
 16
○​ Blood Count: Shows neutrophilia, as neutrophils remain in the blood.
○​ Types:
■​ LAD-1: Defect in integrin.
■​ LAD-2: Associated with Bombay blood group and defect in Sialyl Lewis X.
■​ LAD-3: Defect is formin-3.
●​ Ataxia-Telangiectasia
○​ Buzzwords: Ataxia with immunodeficiency.
●​ Chediak-Higashi Syndrome
○​ Buzzwords: Albinism, neurological dysfunction.
○​ Defect: Problem with lysosomal fusion (LYST gene defect).
●​ DiGeorge Syndrome
○​ Buzzwords: Hypocalcemia with immunodeficiency.
○​ Defect: 22q11.2 microdeletion affecting the 3rd and 4th pharyngeal pouches.
○​ [Mnemonic] CATCH-22: Cardiac defects, Abnormal facies, Thymic aplasia, Cleft palate,
Hypocalcemia/Hypoparathyroidism, 22q deletion.
○​ The 3rd pouch gives rise to the Thymus and Inferior parathyroid glands, explaining the T-cell
abnormality and hypocalcemia.
●​ Terminal Complement Deficiency (MAC Complex Deficiency)
○​ Buzzword: Recurrent Neisseria infections. A favorite of USMLE-style questions.
●​ Wiskott-Aldrich Syndrome
○​ Buzzwords: Easy bleeding (thrombocytopenia), infections, and eczema.
○​ [Mnemonic] A cute baby wearing a TIE: Thrombocytopenia, Infection, Eczema.
○​ Will also have high IgE and IgA levels.
●​ Differential Diagnosis for Umbilical Cord Stump Issues
○​ [Exam Tip]
■​ Late separation of umbilical cord: Think LAD-1.
■​ Bleeding from umbilical cord stump:
■​ In the context of immunodeficiency: Think Wiskott-Aldrich Syndrome.
■​ In the context of coagulation disorders alone: Think Factor XIII deficiency.

Ophthalmology
●​ Neonatal Conjunctivitis: Differential Diagnosis by Onset
○​ < 24 hours: Chemical conjunctivitis, often due to silver nitrate prophylaxis.
○​ 2 to 5 days: Gonococcal conjunctivitis. This is what silver nitrate was intended to prevent. Drug
of choice is Ceftriaxone.
○​ 5 to 14 days: Chlamydial conjunctivitis. This is a frequently asked question.
■​ May also present with neonatal pneumonia.
■​ Drug of choice is Erythromycin.

Myopathies: A Differential Approach

●​ Textual Description of Myopathy Differential Diagnosis Chart
○​ [Exam Tip] The approach is to first look at ESR and CK levels.
 17
○​ ESR Normal, CK Normal:
■​ Clue: Patient has more weakness than pain.
■​ Diagnosis: Glucocorticoid (Steroid)-induced myopathy.
○​ ESR Raised, CK Normal:
■​ Clues: Pain and stiffness in the shoulder and hip girdle (larger joints), associated with
giant cell arteritis.
■​ Diagnosis: Polymyalgia Rheumatica (PMR).
○​ ESR Raised, CK Raised:
■​ Clues: Proximal weakness, may have a rash or arthritis.
■​ Diagnosis: Inflammatory myopathy (e.g., Polymyositis, Dermatomyositis, or Inclusion
Body Myositis).
■​ Dermatomyositis and Polymyositis affect proximal muscles.
■​ Inclusion Body Myositis affects distal muscles and is seen in the elderly.
○​ ESR Normal, CK Raised:
■​ Clue: Primarily pain.
■​ Diagnosis: Statin-induced myopathy.
■​ Coenzyme Q is supplemented with statins to prevent myopathy because statins
block the cholesterol synthesis pathway, which also reduces coenzyme Q.
○​ ESR Normal, CK Raised (or can be high):
■​ Clues: Delayed tendon reflexes, other signs of hypothyroidism (constipation, cold
intolerance).
■​ Diagnosis: Hypothyroid myopathy.

Causes of Secondary Hypertension

●​ Chronic Renal Parenchymal Disease
○​ Clues: Elevated creatinine, proteinuria, RBC casts.
○​ Examples: Chronic glomerulonephritis, pyelonephritis, ADPKD.
●​ Renal Artery Stenosis
○​ Clues: Severe hypertension, abdominal bruit.
○​ [Exam Tip] ACE inhibitors are contraindicated in bilateral renal artery stenosis.
○​ Can be caused by Fibromuscular Dysplasia (FMD).
●​ Hyperaldosteronism (Conn's Syndrome)
○​ Clues: Hypertension with low potassium and high sodium.
●​ Pheochromocytoma
○​ Clues: Adrenal mass with episodic anxiety, headaches, diaphoresis (sweating).
○​ Hypertension is due to excess epinephrine/norepinephrine causing vasoconstriction; it is not
related to the renin-angiotensin system.
●​ Cushing's Syndrome
○​ Clues: Moon-like facies, obesity, muscle weakness (with normal CK and ESR).
○​ Can cause both hypertension and hyperglycemia (diabetes).
●​ Hypothyroidism
○​ Clues: Constipation, weight gain, bradycardia.
○​ [Exam Tip] Hypothyroidism is a surprising but important cause of secondary (often diastolic)
hypertension.
●​ Hyperparathyroidism
 18
○​ Clues: Symptoms of hypercalcemia.
○​ Another subtle cause of secondary hypertension.
●​ Coarctation of the Aorta
○​ Clue: Brachio-femoral delay.

Dermatology & STIs

●​ Genital Ulcers: A Differential Approach
○​ Painful Ulcers
■​ Chancroid: Multiple lesions, "school of fish" appearance on microscopy. Caused by
Haemophilus ducreyi.
■​ Genital Herpes (HSV-2): Multiple, red, vesicular lesions.
○​ Painless Ulcers
■​ Granuloma Inguinale (Donovanosis): Red, "beefy", granulation-like tissue. Caused by
Klebsiella granulomatis.
■​ Syphilis (Primary): Single, indurated ulcer (hard chancre).
■​ Lymphogranuloma Venereum (LGV): The initial ulcer is small, shallow, and transient
(painless), but the patient later presents with painful lymph nodes (buboes). Caused by
Chlamydia trachomatis serovars L1-L3.
●​ Syndromic Management Kits (Color-Coded)
○​ Kit 1 (Grey): For Urethritis/Cervicitis. Treats Gonorrhea & Chlamydia with Cefixime +
Azithromycin.
○​ Kit 2 (Green): For Vaginitis/Vaginal Discharge. Treats BV, Trichomonas, and Candidiasis with
Secnidazole + Fluconazole.
○​ Kit 3 (White): For Non-herpetic Genital Ulcers. Treats Syphilis, Chancroid, Donovanosis with
Benzathine Penicillin + Azithromycin.
○​ Kit 4 (Blue): For Non-herpetic Genital Ulcers with Penicillin Allergy. Replaces Penicillin with
Doxycycline.
○​ Kit 5 (Red): For Genital Herpes (Red Ulcers). Contains Acyclovir.
○​ Kit 6 (Yellow): For Pelvic Inflammatory Disease (PID) / Lower Abdominal Pain. Contains
Doxycycline + Cefixime + Metronidazole.
○​ Kit 7 (Black): For Buboes (LGV). Contains Azithromycin + Doxycycline.

Hematology
●​ Coagulopathies: A Differential Approach
○​ [Exam Tip] Petechiae suggest a platelet problem. Hemarthrosis/Ecchymosis suggest a
coagulation factor problem.
●​ Textual Description of Coagulopathy Differential Diagnosis Chart
○​ Isolated ↑ aPTT: Problem in the intrinsic pathway.
■​ Diagnosis: Hemophilia A (Factor VIII), B (Factor IX), or C (Factor XI).
○​ ↑ Bleeding Time, Normal to ↑ aPTT: Connects platelet dysfunction with coagulation.
■​ Diagnosis: Von Willebrand Disease (impaired platelet plug and decreased Factor VIII
release). This is the most common bleeding disorder.
○​ ↑ PT, ↑ aPTT, ↑ Bleeding Time, ↓ Platelets, ↓ Fibrinogen, ↑ FDPs: Every pathway is affected.
■​ Diagnosis: Disseminated Intravascular Coagulation (DIC).
 19
○​ Isolated ↑ Bleeding Time (with normal platelet count): Platelet number is normal, but function is
not.
■​ Diagnosis: Platelet dysfunction (e.g., Bernard-Soulier Syndrome, Glanzmann's
thrombasthenia, uremia).
○​ Isolated ↑ aPTT (sometimes with thrombocytopenia):
■​ Diagnosis: Heparin use. Heparin blocks Factor II and X (intrinsic pathway). Can
sometimes cause Heparin-Induced Thrombocytopenia (HIT).
○​ ↑ PT, Slightly ↑ aPTT:
■​ Diagnosis: Vitamin K deficiency or Warfarin use. Warfarin blocks factors II, VII, IX, X, so
it affects the extrinsic pathway (PT) more severely but also the intrinsic pathway (aPTT).
○​ ↓ Platelet Count, ↑ Bleeding Time:
■​ Diagnosis: Thrombocytopenia (e.g., ITP).

Respiratory Physiology & Hypoxia

●​ Types of Hypoxia/Anoxia
●​ Textual Description of Hypoxia Differential Diagnosis Chart
○​ ↓ PaO2, ↓ O2 Content, ↓ Saturation: The partial pressure of oxygen in arteries is low. This can
only happen if FiO2 is low.
■​ Cause: High Altitude.
○​ Normal PaO2, ↓ O2 Content, ↓ Saturation: The problem is with hemoglobin's ability to bind
oxygen.
■​ Cause: Carbon Monoxide (CO) Poisoning. CO has ~250x higher affinity for hemoglobin.
Causes a leftward and downward shift of the oxygen dissociation curve, a type of
anemic anoxia.
○​ ↓ O2 Content (with normal PaO2 & Saturation): The amount of hemoglobin is low.
■​ Cause: Anemia. The quality/saturation of each hemoglobin molecule is normal, but the
total quantity is reduced.
○​ ↑ O2 Content:
■​ Cause: Polycythemia.
○​ Normal PaO2, Normal O2 Content, Normal Saturation: The problem is at the cellular level;
tissues cannot use the oxygen.
■​ Cause: Cyanide Poisoning. It blocks Complex IV of the ETC. This is called histotoxic
anoxia.
●​ Mechanisms of Hypoxemia based on A-a Gradient
●​ Textual Description of Hypoxemia Mechanism Chart
○​ [Exam Tip] The approach is to check the A-a gradient and the response to supplemental O2.
○​ Normal A-a Gradient:
■​ High Altitude: FiO2 is low. PCO2 is normal or low. Corrects with O2.
■​ Hypoventilation: Not ventilating enough. PCO2 is high. Corrects with O2.
○​ Increased A-a Gradient: There is a problem between the alveoli and the artery.
■​ Diffusion Limitation: Thickening of the membrane.
■​ Example: Interstitial Lung Disease (ILD).
■​ Corrects with O2.
■​ V/Q Mismatch: Reduced ventilation to perfused areas.
■​ Examples: Obstructive lung disease, pneumonia, consolidation, collapse.
 20
■​ Corrects with O2.
■​ Shunt: No ventilation to perfused areas (V=0).
■​ Examples: Anatomic shunt, extensive ARDS.
■​ Does NOT correct with supplemental O2. This is the defining feature.
■​ Dead Space: Ventilation to non-perfused areas (Q=0).
■​ Example: Pulmonary Embolism. This was not in the described chart but is a key
concept.

Infectious Diseases - Diarrhea & Food Poisoning

●​ Early Onset (<6 hours) - Preformed Toxin
○​ Chinese food (reheated rice): Bacillus cereus.
○​ Dairy, mayonnaise, meats: Staphylococcus aureus.
■​ [Exam Tip] Vomiting is more dominant than diarrhea in Staph aureus food poisoning.
●​ Later Onset (>6 hours)
○​ Traveler's diarrhea: ETEC.
○​ Rice water stool: Vibrio cholerae.
○​ Shellfish: Vibrio parahaemolyticus. (V. vulnificus is associated with sepsis).
○​ Malabsorption: Giardia lamblia.
○​ Mimicking appendicitis: Yersinia enterocolitica.
○​ History of antibiotic use: Clostridioides difficile (pseudomembranous colitis).
●​ Bloody Diarrhea (Dysentery)
○​ Poultry, eggs: Salmonella.
○​ High fever, seizures: Shigella.
○​ Associated with GBS: Campylobacter jejuni.
○​ Associated with HUS: EHEC.
○​ Can also be caused by Entamoeba histolytica.

Pediatrics & ENT

●​ Causes of Stridor: A Differential Approach
●​ Textual Description of Stridor Differential Diagnosis Chart
○​ Stridor with a "barking" cough: Croup (Laryngotracheobronchitis). Most commonly caused by
the parainfluenza virus.
○​ Stridor that worsens in supine, improves in prone: Laryngomalacia.
■​ Seen in 4-8 month old infants.
■​ Laryngoscopy shows an omega-shaped epiglottis.
○​ Acute onset stridor: Foreign body aspiration.
○​ Stridor that improves with neck extension: Vascular ring.
■​ Associated with cardiac abnormalities like a double aortic arch, which compresses the
trachea.

Movement Disorders
 21
●​ Types of Tremors
●​ Textual Description of Tremor Differential Diagnosis Chart
○​ Essential Tremor:
■​ Type: Action tremor.
■​ Clues: Can involve the head. Relieved with alcohol. Can be familial.
■​ Treatment: Beta-blockers (Propranolol).
○​ Parkinsonian Tremor:
■​ Type: Resting tremor (4-6 Hz).
■​ Clues: "Pill-rolling" quality.
○​ Cerebellar (Intention) Tremor:
■​ Type: Tremor increases as the limb approaches a target.
■​ Clues: Associated with other cerebellar signs.
○​ Physiological Tremor:
■​ Type: Low amplitude, not visible under normal conditions.
■​ Clues: Acute onset, worse with high sympathetic states (e.g., anxiety, caffeine). Can
involve face and extremities.

Obstetrics & Gynecology

●​ Types of Abortion
●​ Textual Description of Abortion Differential Diagnosis Chart
○​ [Exam Tip] The first step is to check if the cervical os is open or closed.
○​ Os is Open:
■​ Inevitable Abortion: Possible fetal cardiac activity may be present (but usually is
negative). The process cannot be stopped.
■​ Incomplete Abortion: Some products of conception are seen in the uterus/cervix.
○​ Os is Closed:
■​ Threatened Abortion: The only type where fetal cardiac activity is positive and the
pregnancy can potentially proceed. Presents with bleeding.
■​ Complete Abortion: No products of conception are seen on ultrasound.
■​ Missed Abortion: A non-viable fetus is retained in the uterus.
○​ Septic Abortion:
■​ Any of the above with secondary infection.
■​ Clues: Fever, foul-smelling vaginal discharge, cervical motion tenderness.
●​ Liver Diseases in Pregnancy
○​ Intrahepatic Cholestasis of Pregnancy (ICP)
■​ Hallmark: Pruritus, elevated bile acids.
■​ Management: Induction of labor at 37 weeks (term).
○​ HELLP Syndrome
■​ Hallmark: Thrombocytopenia (and Hemolysis, Elevated Liver enzymes).
■​ Management: Immediate termination of pregnancy, irrespective of gestational age.
○​ Acute Fatty Liver of Pregnancy (AFLP)
■​ Hallmark: Hypoglycemia, signs of liver failure.
■​ Management: Immediate termination of pregnancy.
●​ Causes of Acute Pelvic Pain in Women
○​ Mittelschmerz: Pain around ovulation.
 22
○​ Ruptured Ectopic Pregnancy: Positive hCG, pain, bleeding.
○​ Ovarian Torsion: Ovary is enlarged with decreased blood flow.
○​ Ruptured Ovarian Cyst: Ultrasound shows free fluid near a cyst.
○​ Pelvic Inflammatory Disease (PID): Fever, tenderness.
●​ Disorders of Sexual Development (DSD)
○​ 46, XY with female phenotype: Androgen Insensitivity Syndrome.
○​ 46, XX with primary amenorrhea:
■​ Defective uterus and upper vagina: Mullerian Agenesis.
■​ Normal uterus, abnormal lower vagina: Transverse vaginal septum or imperforate
hymen.
○​ 45, X: Turner Syndrome.

Toxicology
●​ Acute Drug Intoxication
●​ Textual Description of Drug Intoxication Chart
○​ Hallucinogens
■​ PCP (Phencyclidine, "Angel Dust"): Violent behavior, nystagmus.
■​ LSD ("Acid"): Visual hallucinations, synesthesia.
○​ Stimulants
■​ Cocaine: Tachycardia, hypertension, mydriasis, possible nasal septal perforation.
■​ Amphetamines (Meth, Ecstasy, MDMA): Violence, choreoathetoid movements, severe
tooth decay ("meth mouth").
○​ Cannabis ("Marijuana"): Increased appetite, conjunctival injection (bloodshot eyes), slowed
perception of time.
■​ Street names: Ganja, charas, hashish. Hash oil is reportedly the most potent.
○​ Opioids (Heroin): This is a depressant.
■​ Buzzwords: Respiratory depression, miosis (pinpoint pupils), euphoria.
■​ Street names: Smack, brown sugar, dope.
●​ Alcohol Intoxication
●​ Textual Description of Alcohol Intoxication Chart
○​ Ethanol: High osmolar gap, high anion gap metabolic acidosis (HAGMA), slurred speech.
○​ Methanol: High osmolar gap, HAGMA, visual blurring/blindness (due to formic acid).
○​ Ethylene Glycol (Antifreeze): High osmolar gap, HAGMA, calcium oxalate crystals in urine.
○​ Isopropyl Alcohol: High osmolar gap, but NO HAGMA. This is a key distinguishing feature.

Orthopedics
●​ Differential Diagnosis of Anterior Knee Pain
○​ Patellofemoral Pain Syndrome:
■​ Context: Young female athlete.
■​ Pain: Anterior knee pain, worse with squatting, running, stairs.
○​ Patellar Tendinitis ("Jumper's Knee"):
■​ Pain: Localized to the inferior pole of the patella.
○​ Osgood-Schlatter Disease:
■​ Context: Adolescent athlete.
 23
■​ Pain: Tenderness at the tibial tubercle (apophysitis). This is the most likely diagnosis to be
asked.
●​ Differential Diagnosis of Foot Pain
●​ Textual Description of Foot Pain Differential Diagnosis Chart
○​ Stress Fracture:
■​ Clue: Recent, rapid increase in training intensity (e.g., a sedentary person who suddenly
starts running marathons).
○​ Plantar Fasciitis:
■​ Clue: Pain is worst on the first step in the morning or after a period of rest.
○​ Achilles Tendinopathy/Tear:
■​ Clue: Pain is localized 2-6 cm above the calcaneal insertion.
○​ Morton's Neuroma:
■​ Clue: Numbness or pain between the 3rd and 4th toes. A "squeeze test" elicits pain. It's a
fibrosis of the interdigital nerve.
○​ Tarsal Tunnel Syndrome:
■​ Clue: Compression of the posterior tibial nerve, causing neuropathy-like pain along the
nerve's distribution.

Otorhinolaryngology (ENT)
●​ Common Causes of Vertigo
●​ Textual Description of Vertigo Differential Diagnosis Chart
○​ Meniere's Disease: Vertigo with unilateral sensorineural hearing loss, tinnitus, and aural
fullness.
○​ Benign Paroxysmal Positional Vertigo (BPPV): Movement-induced vertigo, diagnosed with the
Dix-Hallpike maneuver.
○​ Vestibular Neuritis / Labyrinthitis: Vertigo following a viral syndrome. A very common cause.
○​ Vestibular Migraine: Vertigo associated with headaches or a history of migraines.
○​ Cerebellar Stroke/Lesion: Sudden onset, persistent vertigo with other neurological
symptoms.

Flaccid Paralysis: A Differential Approach

●​ Botulism: Descending flaccid paralysis.
○​ Food-borne botulism: From preformed toxin.
○​ Infant botulism: From ingestion of spores.
●​ Guillain-Barré Syndrome (GBS): Ascending flaccid paralysis.
●​ Poliomyelitis: Asymmetric flaccid paralysis. Affects the anterior horn cells.

Lecturer's Side Comments & Study Advice

●​ On Memorization: The lecturer advises against rote memorization of buzzwords. The goal is for the
associations to become natural through understanding and repeated exposure.
●​ On Using UWorld: The lecturer notes that many of the charts and questions are modified from UWorld.
They reassure students that they are getting sufficient exposure to USMLE-style content and do not need
to purchase a separate UWorld subscription.
 24
●​ On Study Strategy: This high-yield buzzword review should be an endpoint of study, not a starting point
or a shortcut. A solid foundation from comprehensive BTR (Buzzwords, a Topic, a Review) lectures and
PYQs is essential.
●​ Future Class Schedule:
○​ The lecturer recommends studying Radiology for 2 days then Orthopedics for 3 days.
○​ Radiology classes (Mission NEET/FMG) would be made available to BTR subscribers on the 9th
and 10th.
○​ A combined END (exam) would be held on the 14th.
○​ The lecturer mentions that the radio classes are available under the BTR section in the app.