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First Aid for the USMLE Step 2 CK (8th Ed.) | Medicine (MD/DO) School Study Aid

Acute Lymphoblastic Leukemia (ALL)

Ages < 15

May Present with Bone Marrow Involvement in Children

Mediastinal Mass in Adolescents

TdT Positive

CALLA Positive

t(12;21) Better Prognosis

Spread to CNS and Testes

Most Responsive to Chemotherapy

2 mins

Acute Myelogenous Leukemia (AML)

Myeloblasts Increase on Peripheral Smear

Median Onset 60 Years

T 15;17 M3 Subtype

Auer Rods

Disseminated Intravascular Coagulation (DIC) is a Common Presentation

M5 Gum Infiltration

Responds to Vitamin A

3 mins

Meningitis Interventions

IV Antibiotics

Dexamethasone

Analgesics

Antipyretics

Closely Monitor for Increased ICP

Bed Rest

Preventative Vaccinations

Droplet-Airborne Precautions

2 mins

Meningitis Assessment

Nausea and Vomiting

Fever

Nuchal Rigidity

Severe Headache

Purpura

Seizures

Photophobia

Opisthotonus Position

High-Pitched Cry

Bulging Fontanel

2 mins

Neisseria Meningitidis

Gram-Negative

Diplococci

Chocolate Agar

Thayer-Martin Media

VPN

Oxidase-Positive

Maltose Fermentation

Glucose Fermentation

Endotoxin

Lipooligosaccharide (LOS) in Membrane

Polysaccharide Capsule

IgA Protease

Waterhouse Friderichsen Syndrome

Adrenal Insufficiency

Petechial Rash

Ceftriaxone

Rifampin Prophylaxis

5 mins

Osteosarcoma

Osteogenic Sarcoma

Peak incidence men 10-20 years old

Metaphysis of Long Bones

Knee Region

Radiation

Familial Retinoblastoma

Paget's Disease

Codman Triangle

Sunburst Pattern from Elevated Periosteum

Grave Prognosis

2 mins

Turner Syndrome

Female (XO)

Short stature

Shield Chest

Cystic Hygroma (Webbing of Neck)

Lymphedema in Hands and Feet

Ovarian Dysgenesis

Streak Ovary

Decreased Estrogen

Increased FSH

Increased LH

Dysgerminoma

Bicuspid Aortic Valve

Preductal Coarctation of the Aorta

Horseshoe Kidney

Menopause before Menarche

Amenorrhea

5 mins

Patent Ductus Arteriosus

Continuous

Machine like murmur

Often Due to Congenital Rubella

Prematurity

1 min

Tetralogy of Fallot (TOF)

Blue Baby Syndrome

PROVe Acronym

Pulmonary Infundibular Stenosis

Right Ventricular Hypertrophy

Overriding Aorta

Ventricular Septal Defect (VSD)

Boot-Shaped Heart

Squatting for Tet Spells

Surgery

2 mins

Age 2 Months - Developmental Milestones

Holds Head Up, But Unsteady

Moves Both Arms and Both Legs

Opens Hands Briefly

Tracks Objects to the Midline

Produces Sounds Aside from Crying

Reacts to Loud Noise

Social Smile

Recognizes Parents

Soothed When Spoken to or Picked Up

2 mins

Age 4 Months - Developmental Milestones

Keeps Head Steady Without Support

Pushes Up on Elbows While on Tummy

Holds a Toy in Hands

Moves Hands Towards Mouth

Cooing

Turns to Voice

Chuckles

Enjoys Looking Around

Looks at Hands With Interest

Opens Mouth When Hungry

2 mins

Age 6 Months - Developmental Milestones

Sits Propped Up On Hands

Rolls

Raking Grasp

Makes Squealing Noises

Blows "Raspberries"

Turn-Taking in Sounds

Laughs

Enjoys Looking at Self in a Mirror

Recognizes Familiar People

Closes Lips to Signal Fullness

Puts Objects in Mouth

Reaches for Desired Toys

2 mins

Age 9 Months - Developmental Milestones

Sits Up Independently

Transfers Objects Between Hands

Uses Fingers to Pull Food Toward Self

Produces Various Sounds Like "mamamama" and "bababababa"

Raises Arms to be Lifted Up

Separation Anxiety

Shows Facial Expressions

Looks When Calling Name

Smiles or Laughs at Peek-a-boo

Looks for Dropped Objects Out of Sight

Bangs Two Items Together

2 mins

Age 1 Year - Developmental Milestones

Pulls Up to Stand

First Steps

Drinks From an Open Cup with Assistance

Two-Finger Pincer Grasp

Understands “No”

Waves "Bye-Bye"

"Mama & Dada"

Plays Pat-A-Cake

Puts Block in Cup

Searches for Hidden Toys

2 mins

Age 18 Months - Developmental Milestones

Walks Independently

Climbs On/Off Furniture Without Help

Drinks from Open Cup Independently

Scribbles

Eats with Fingers

Tries to Use a Spoon

Stacks Three Blocks

Attempts Three-word Phrases

Follows One-step Commands

Checks While Moving Away

Points to Objects

Engages With Toys Simply

Copies Parent Doing Chores

Extends Hands for Washing

2 mins

Age 2 Years - Developmental Milestones

Kicks a Ball

Runs

Walks Up Stairs With Help

Stacks Six Blocks

Feeds Self With a Spoon

Two-Word Phrases

Points to Book Items as Prompted

Demonstrates Varied Gestures

Identifies Body Parts When Prompted

Shows Empathy

Holds and Manipulates Objects Simultaneously

Engages With Multiple Toys

2 mins

Age 3 Years - Developmental Milestones

Starts Dressing Independently

Rides Tricycle

Stack Nine Block Tower

Threads Items Together

Copies Circle

Uses Fork

Engages in Two-way Conversation

75% Speech Understood by Stranger

Says First Name

Avoids Hot Objects When Warned

Joins Other Kids in Play

2 mins

Age 4 Years - Developmental Milestones

Unbuttons Some Buttons

Catches a Large Ball

Serves Food or Pours Water With Help

Copies Line, Circle, Stick Figure

100% Speech Understandable

Identifies Colors

Cooperative Play

Imaginary Friends

Likes Being a “Helper”

Avoids Danger

2 mins

Cystic Fibrosis Mechanisms

Autosomal Recessive

CFTR Chromosome 7

Cl- channel Defect

Decreased Chloride Secretion

Increased Na and Water Reabsorption

Increased Na and Cl in Sweat

Dehydration of Mucous Layers

2 mins

Cystic Fibrosis Diagnosis and Treatment

Sweat Chloride Test > 60 mmol/L

Meconium Ileus

N-acetylcysteine

Antibiotic Prophylaxis

Pulmonary Maintenance

Lung Transplant

Vitamin Replacement

1 min

Cystic Fibrosis Symptoms and Complications

Recurrent Pulmonary Infections

Chronic Bronchitis

Nasal Polyps

Pancreatic Insufficiency

Intestinal Obstruction

Malabsorption and Diarrhea

Vitamin Deficiencies

Chronic Hepatic Disease

Infertility in Males

1 min

Down Syndrome

Trisomy 21

Meiotic Nondisjunction

Intellectual Disability (Mental Retardation)

Single palmar crease

Flat Facies

Duodenal Atresia

Hirschsprung's Disease

Septum Primum Type ASD

Endocardial Cushion Defects

Prominent Epicanthal Folds

Increased Risk of Acute Lymphoblastic Leukemia

Alzheimer's Disease

3 mins

Edwards Syndrome

Trisomy 18

Intellectual Disability (Mental Retardation)

Rocker Bottom Feet

Ventricular Septal Defect (VSD)

Clenched Hands

Overlapping Fingers

Low-Set Ears

Micrognathia

Prominent Occiput

Omphalocele

Meckel's Diverticulum

Horseshoe Kidney

Malrotation of Intestines

3 mins

Klinefelter's Syndrome

Male (XXY)

Eunuchoid Body Shape

Gynecomastia and Female Hair Distribution

Testicular Atrophy

Dysgenesis of Seminiferous Tubules

Possible Developmental Delay

Hypogonadism

Decreased Inhibin B

Increased FSH

Abnormal Leydig Cell Function

Decreased Testosterone

Increased LH

Increased Estrogen

Barr body (inactivated X chromosome)

6 mins

Patau Syndrome

Trisomy 13

Severe Intellectual Disability

Microcephaly

Holoprosencephaly

Microphthalmia

Polydactyly

Cleft Lip/Cleft Palate

Rocker Bottom Feet

Omphalocele

Cystic Kidneys

Ventricular Septal Defect (VSD)

2 mins

Fragile X

Trinucleotide Repeat

CGG Repeats

FMR1 Gene

X-linked Dominant

Developmental Delay

Autism

Large Ears

Large Jaw

Long Face

Macroorchidism

2 mins

Phenylketonuria (PKU)

Decreased Phenylalanine Hydroxylase

Decreased Tetrahydrobiopterin Cofactor

Autosomal Recessive

Tyrosine Becomes Essential

Phenylalanine Found in Nutrasweet

Musty or Mousy Body Odor

Growth Retardation

Seizures

Intellectual Disability

Hypopigmentation

2 mins

Fabry's Disease

X-linked Recessive

Alpha-galactosidase A Deficiency

Increased Ceramide trihexoside

Decreased Sweating (Hypohidrosis)

Angiokeratoma

Episodic Peripheral Neuropathy

Cardiovascular Disease

Renal Failure

1 min

Gauchers Disease

Autosomal Recessive

Beta Glucocerebrosidase Deficiency

Lipid-laden Macrophages

Crumpled Tissue Paper

Osteoporosis

Bone Crises

Aseptic Necrosis of Femur

Erlenmeyer Flask Deformity

Hepatosplenomegaly

Pancytopenia

2 mins

Hunter Syndrome

X-linked Recessive

Mucopolysaccharidoses

Iduronate Sulfatase Deficiency

Increased Dermatan Sulfate

Increased Heparan Sulfate

No Corneal Clouding

Aggressive Behavior

1 min

Hurler Syndrome

Autosomal Recessive

Mucopolysaccharidoses

Alpha-L-Iduronidase Deficiency

Increased Heparan Sulfate

Increased Dermatan Sulfate

Hepatosplenomegaly

Developmental Delay

Gargoylism

Corneal Clouding

Airway Obstruction

2 mins

Krabbe Disease

Autosomal Recessive

Galactocerebrosidase Deficiency

Increased Psychosine

Developmental Delay

Peripheral Neuropathy

Optic Atrophy

Globoid Cells

1 min

Metachromatic Leukodystrophy

Autosomal Recessive

Arylsulfatase A Deficiency

Increased Cerebroside Sulfate

Demyelination

Ataxia

Dementia

1 min

Niemann-Pick Disease

Autosomal Recessive

Sphingomyelinase Deficiency

More Common in Ashkenazi Jewish Population

Cherry Red Spot on Macula

Hepatosplenomegaly

Neurodegeneration

Foam Cells

1 min

Tay-Sachs Disease

Autosomal Recessive

Hexosaminidase A Deficiency

Increased GM2 Ganglioside

More Common in Ashkenazi Jewish Population

Cherry Red Spot on Macula

Neurodegeneration

Developmental Delay

Onion Skin Lysosomes

1 min

Intussusception

Telescoping of Bowel Segments

Lead Point

Episodic Abdominal Pain

Diarrhea

Sausage-Shaped Mass

Red Currant Jelly Stools

Ultrasound/CT

Target Sign

More Common in Children

Rotavirus Vaccine Contraindicated

Air or Hydrostatic Enema

Surgical Reduction

3 mins

Hypertrophic Pyloric Stenosis (HPS) Assessment

Hypertrophied Pylorus

Macrolide Use

3-6 Weeks of Age

Projectile Vomiting After Feeding

No Pain or Discomfort

Weight Loss

Dehydration

Hungry Baby

Olive Mass

2 mins

Hypertrophic Pyloric Stenosis (HPS) Interventions

Pyloromyotomy

Stabilize Fluid and Electrolyte Balance

Nasogastric Tube

Monitor Feeding

Start Formula or Breastfeeding Within 24 Hours

Feedings Every 4-6 hours

Full Feeding Within 2 days

2 mins

Hirschsprung Disease

Failure of Neural Crest Cell Migration

Involves Rectum

Lack of Auerbach and Meissner Plexus

Chronic Constipation

Failure to Pass Meconium

Congenital Megacolon

Increased Risk with Down Syndrome

RET Mutations

2 mins

Meckel's Diverticulum

True Diverticulum

Vitelline Duct

Yolk Stalk

Contain Ectopic Tissue

Pancreatic And Gastric Mucosa

Hemorrhage

Intussusceptions

Volvulus

2 Feet From Ileocecal Valve

2 Inches Long

2% Population

First 2 Years Of Life

Pertechnetate T99

2 mins

Bruton's Agammaglobulinemia

X-linked Recessive

Defective Bruton Tyrosine Kinase

Blocks B Cell Maturation

Decreased Immunoglobulins of All Classes

Bacterial Infections After Six Months

Maternal IgG Protects Before Six Months

2 mins

Common Variable Immunodeficiency

Defect in B Cell Maturation

Decreased Plasma Cells

Decreased Immunoglobulins

Sinopulmonary Infections

Increased Risk of Autoimmune Disease

Lymphoma

1 min

Selective IgA Deficiency

Defect in Class Switching

Decreased IgA

Often Asymptomatic

Increase in Atopic & Autoimmune Diseases

Sinopulmonary Infections

Increased Risk Giardia Lamblia Infections

Inflammatory Bowel Disease

Celiac Disease

Anaphylaxis From IgA Containing Blood Products

2 mins

Thymic Aplasia (DiGeorge Syndrome)

DiGeorge Syndrome

22q11 Deletion

Failure to Develop Third and Fourth Pharyngeal Pouches

Undeveloped Thymus

T Cell Deficiency

Recurrent Viral and Fungal Infections

Undeveloped Parathyroids

Hypocalcemia

Tetany

Aortic Defects

Congenital Heart Defects

Absent Thymic Shadow on CXR

2 mins

Ataxia Telangiectasia

Autosomal Recessive

ATM Gene

Defect in DNA repair

Cerebellar defects

Spider Angiomas

Sensitive to Radiation

Defective Tumor Suppressor Gene

Increased risk of Cancer, Leukemias, and Lymphomas

Increased AFP levels

IgA deficiency

Repeated sinopulmonary infections

2 mins

Chronic Granulomatous Disease

Most Commonly X-linked Recessive

Defective NADPH Oxidase (Enzyme Complex)

Decreased Hydrogen Peroxide

Impaired Intracellular Killing in Phagocytes

Recurrent Purulent Skin and Lung Infections

Catalase Positive Organisms

Negative Nitroblue Tetrazolium Test

DHR (Dihydrorhodamine) Flow Cytometry

Antimicrobial Prophylaxis

TMP-SMX

Itraconazole

Interferon-Gamma

3 mins

Leukocyte Adhesion Deficiency

Autosomal Recessive

Integrin CD18 Protein

Defect in LFA-1

Attached to ICAM

Neutrophilia

Bacterial Infections

Non-Pyogenic

Delayed Separation of Umbilical Cord

2 mins

Severe Combined Immunodeficiency (SCID)

Both B and T Cell Deficiency

Recurrent Viral, Bacterial, Fungal, Protozoal Infections

Defective Interleukin (IL) 2 Receptor

X-Linked

Adenosine Deaminase Deficiency

Failure to Synthesize MHC II Antigens

Treat with Bone Marrow Transplant

2 mins

Wiskott Aldrich

X-linked Recessive

WASp Protein Mutation

Antigen Presentation Defect

Progressive Deletion of B and T Cells

Thrombocytopenia

Eczema

Infections

Decreased IgM

Increased IgE, IgA

2 mins

Chediak-Higashi Syndrome

Autosomal Recessive

Defective Lysosomal Trafficking Regulator Gene (LYST)

Defect In Microtubular Function

Decrease In Phagocytosis

Recurrent Pyogenic Infections

Staph Aureus And Streptococci

Partial Albinism

Peripheral Neuropathy

Pancytopenia

Giant Granules In Granulocytes And Platelets

2 mins

Hyper IgE Syndrome

Job Syndrome (Autosomal Dominant Hyper IgE Syndrome)

Autosomal Dominant

STAT3 Mutation

Increased IgE

Abnormal Chemotaxis

Leonine Facies

Cold (Non-Inflamed) Staph Aureus Abscesses

Retained Primary Teeth

Eczema

Prophylactic Antibiotics

2 mins

Kawasaki Disease

Prevalent in Asian Children

Necrotizing Vasculitis

Fever

Strawberry-Red Tongue and Mucosa

Lymphadenopathy

Desquamative Skin Rash

Erythema and Edema of the Hands and Feet

Conjunctivitis

Coronary Aneurysm

Intravenous Immunoglobulin (IVIG)

Aspirin

2 mins

Respiratory Syncytial Virus (RSV) Assessment

Viral Infection Affecting Epithelial Cells

Begins After a Upper Respiratory Infection

Copious Secretions

Coughing and Sneezing

Wheezing

Otitis Media or Conjunctivitis (Possible Ear or Eye Drainage)

Poor Feeding

Tachypnea

2 mins

Respiratory Syncytial Virus (RSV) Interventions

Palivizumab (Synagis)

Hospitalization

Contact Precautions

Oxygen

Separate Room

Maintain Fluid Intake

Short-acting Beta-Agonist Bronchodilator

2 mins

Croup (Laryngotracheobronchitis)

Parainfluenza Virus

3 Months to 3 Years

Nighttime

Barking Seal Cough

Inspiratory Stridor

Cool Humidified Air

Dexamethasone

Racemic Epinephrine

2 mins

Haemophilus Influenzae Disease

Pneumonia

Cherry Red Epiglottitis

Meningitis

Otitis Media

COPD Exacerbation

Thumbprint Sign (on X-ray)

Rifampin Prophylaxis

Ceftriaxone

2 mins

Bordetella pertussis

Gram-Negative

Coccobacillus

Bordet-Gengou Agar

ADP Ribosylating AB Toxin

Inhibits Gi to cause Increase in cAMP

Lymphocytosis

Increase in Insulin

Catarrhal Phase is Infectious Period

Paroxysmal Phase is Symptomatic Period

Whooping Cough

Macrolides

4 mins

Exanthema Subitum (Roseola Infantum)

Human Herpesvirus Type 6

Sudden High Fever

Maculopapular, Nonpruritic Rash

Febrile Seizures

Tepid Baths

Ibuprofen

Acetaminophen

2 mins

Paramyxovirus

Enveloped

RNA Virus

Helical

SS Negative Linear

Nonsegmented

Surface Fusion Protein Causes Multinucleated Cells

Measles

Mumps

Bronchiolitis in Babies

Parainfluenza

Respiratory Syncytial Virus (RSV)

2 mins

Parvovirus B19

DNA

Single Stranded

Linear

Smallest DNA virus

Non-enveloped

5th Disease

Slapped Cheek Rash in Children

Erythema Infectiosum

Hydrops Fetalis

RBC aplasia

Arthritis in Adults

Aplastic Crisis in Sickle Cell

Myocarditis

2 mins

Rubella

RNA Virus

Matonaviridae

Enveloped

Icosahedral

SS Positive Linear

German Measles or Three-Day Measles

Fever

Postauricular Tenderness

Lymphadenopathy

Truncal Rash

Arthritis

Congenital TORCH Infection

2 mins

APGAR Score

1 and 5 Minutes

Appearance

Pulse

Grimace

Activity and Muscle Tone

Respiration

Total Scores

Gentle Stimulation

Oxygen

2 mins

Coxsackievirus

Picornavirus

Coxsackie A

Febrile Pharyngitis

Hand, Foot, and Mouth Disease

Most Common Cause of Aseptic Meningitis

Late Summer

Coxsackie B

Myocarditis

Dilated Cardiomyopathy

Type 1 Diabetes

2 mins

Tracheoesophageal Fistula (TEF)

Esophageal Atresia

Ends in Blind Pouch

Coughing

Choking

Cyanosis

Drooling

NPO

Surgical Emergency

Aspiration Pneumonia

2 mins

Leukemia Assessment

Immature WBCs

Recurrent Infections

Easy Bruising

Bleeding

Anemia

Fatigue

Weight Loss

Bone Pain

May Have Normal or High WBC Count

2 mins

Leukemia Interventions

Bone Marrow Aspiration

X-Rays

Chemotherapy

Bleeding Precautions

Neutropenic Precautions

Strict Asepsis

Bone Marrow Transplant

Blood Transfusions

Monitor Temperature Elevations

Adequate Nutrition

Imatinib (Gleevec) for Chronic Myelogenous Leukemia (CML)

3 mins

Wilms' Tumor (Nephroblastoma)

Malignant Renal Tumor

Abdominal Mass

Hematuria

Fever

Hypertension

Nephrectomy

Chemotherapy

Radiation

Do Not Palpate Abdomen

Children Under 5 Years Old

2 mins

Ewing's Sarcoma

Most Common in Boys < 15 years old

11;22 Translocation

Long bones, Pelvis, Ribs

Diaphysis

Small Blue Cells

Malignant

Aggressive

Onion-skin Appearance

Responsive to Chemotherapy

2 mins

Lead Antidotes

Dimercaprol

CaEDTA

Succimer

39 secs

Varicella Zoster Virus (VZV)

Herpesvirus 3

Enveloped

Double Stranded DNA

Chickenpox

Pneumonia

Encephalitis

Trigeminal and Dorsal Root Ganglia

Shingles

Tzanck Test

Multinucleated Giant Cells

Cowdry A Inclusion

Acyclovir

2 mins

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