Rheum| Antibody Review
Step 1 Basics (USMLE)
4.11 Antibody Review Rheumatology review for the USMLE Step 1 Exam. ANA Principles ANA (Anti-Nuclear Antibody): Non-specific antibody. Reacts against nuclear antigens, including proteins, DNA, RNA, and nucleic acid-protein complexes. Includes a group of antibodies such as anti-dsDNA, anti-histone, SSA/Ro, SSB/La, Scl-70, anti-aminoacyl-tRNA synthetase (Jo-1). Found in 20-30% of the general public without connective tissue disorder symptoms. ANA+ individuals may or may not have a rheumatologic disorder. Further workup is needed in ANA+ cases to determine the specific disorder. Antibodies...
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Rheum| Gout and Pseudogout
Step 1 Basics (USMLE)
4.10 Gout and Pseudogout Rheumotology review for the USMLE Step 1 Exam. Gout Caused by uric acid crystal deposition due to purine metabolism. Triggers inflammation when crystals precipitate in cooler joint fluid. Presents with severe, red, and swollen monoarticular joints, often in the big toe. Diagnosis through synovial fluid analysis. Acute treatment: colchicine, NSAIDs, and glucocorticoids. Preventive treatment: allopurinol, febuxostat, probenecid, and lifestyle changes. Pseudogout Resulting from calcium pyrophosphate crystal deposition, often due to ATP breakdown. Manifests with...
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Rheum| Rheumatologic Emergencies
Step 1 Basics (USMLE)
4.09 Rheumatologic Emergencies Rheumatology review for USMLE Step 1 Exam Giant Cell Arteritis (GCA) A large vessel vasculitis, mainly in older individuals. Symptoms: headache, jaw claudication, vision loss. Ischemia from granulomas in large vessels causes vision loss. Immediate high-dose corticosteroids are crucial. Scleroderma Renal Crisis A complication of scleroderma. Symptoms: finger edema, skin tightening, sudden hypertension, rising creatinine. Renal artery fibrosis leads to high blood pressure. Treat with IV ACE inhibitor, not steroids. Acute Transverse Myelitis in SLE Inflammation...
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Cardio| Systolic Heart Murmurs
Step 1 Basics (USMLE)
1.06 Systolic Heart Murmurs Cardiovascular system review for the USMLE STEP 1 Exam Heart murmurs are caused by turbulent blood flow in the heart There are 4 different types of systolic murmurs: ventricular septal defect (VSD), patent ductus arteriosus (PDA), aortic stenosis, and mitral or tricuspid regurgitation PDA produces a constant, machine-like murmur VSD produces a harsh holosystolic murmur Aortic stenosis produces a crescendo-decrescendo systolic ejection murmur Mitral and tricuspid regurgitation produce a holosystolic high pitched "blowing" murmur Mitral valve prolapse...
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Psych| OCD and Related Disorders
Step 1 Basics (USMLE)
5.13 OCD and Related Disorders Psych review for the USMLE Step 1 Exam Obsessive Compulsive Disorder (OCD): Unwanted thoughts (obsessions) and repetitive behaviors (compulsions). Treat with CBT + SSRIs/SNRIs. Tic Disorders: Tourette Syndrome involves multiple motor and at least one vocal tic. Treat with Habit Reversal Therapy. Body Dysmorphic Disorder: Preoccupation with minor flaws, treat with SSRIs and CBT. Trichotillomania: Hair pulling disorder, treat with Habit Reversal Training and sometimes SSRIs. PANDAS: Pediatric disorder after strep infection, sudden OCD-like symptoms. Treat with...
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Psych| Anxiety Related Disorders
Step 1 Basics (USMLE)
5.12 Anxiety Related Disorders Psychiatry review for the USMLE Step 1 Exam Anxiety is a normal response to threats or stressors in the environment Anxiety disorders occur when anxiety causes significant distress or impairment in functioning Generalized Anxiety Disorder (GAD) involves persistent and excessive worry about various aspects of daily life for at least 6 months, accompanied by physical symptoms Treatment for GAD typically involves a combination of cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) Panic Disorder is diagnosed in individuals who...
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Psych| Eating and Feeding Disorders
Step 1 Basics (USMLE)
5.11 Eating and Feeding Disorders Psychiatry Review for the USMLE Step 1 Exam Eating Disorders: Main disorders: bulimia nervosa, anorexia nervosa, and binge eating disorder. Bulimia and anorexia share anxiety and compensatory behaviors. Anorexia: low body weight, fear of gaining weight, treatment involves slow refeeding. Bulimia: normal weight, signs of forced vomiting, treated with CBT and SSRIs. Binge Eating Disorder: uncontrollable eating, negative emotions, SSRIs and CBT for treatment. Feeding Disorders: Occur in children, not related to body image. Common disorders:...
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Psych| Mood Disorders (Grief, Depression, and Bipolar)
Step 1 Basics (USMLE)
5.10 Mood Disorders (Depression and Bipolar) Psychiatry Review for the USMLE Step 1 exam Mood disorders are persistent disruptions in emotion, categorized into bipolar disorders and depressive disorders. Bipolar disorders are characterized by manic or hypomanic episodes, while depressive disorders feature periods of depression. Major Depressive Disorder (MDD) is characterized by feelings of sadness, guilt, worthlessness, and anhedonia lasting for at least two weeks. SIG E CAPS is an acronym used to remember the symptoms of depression: Sleep changes, Interest loss, Guilt, Energy loss,...
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Psych| Schizophrenia
Step 1 Basics (USMLE)
5.09 Schizophrenia Psychiatry review for the USMLE Step 1 Exam Epidemiology: Slight male predilection (1.4:1 male to female ratio). Men present between 18-25, women between 28-35. Affects about 0.5% of the population. Symptoms: Positive symptoms: hallucinations, delusions, disorganized behavior and speech. Negative symptoms: flat affect, anhedonia, apathy, alogia, lack of interest in socialization. Cognitive symptoms: impairments in attention, executive function, working memory. Diagnosis: Criteria: two or more symptoms lasting over a month. Schizophreniform disorder if symptoms last...
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Psych| Cluster C Personality Disorders
Step 1 Basics (USMLE)
5.08 Cluster C Personality Disorders Psychiatry review for the USMLE Step 1 Exam Introduction: Cluster C personality disorders = anxious/worried. Disorders: avoidant, obsessive-compulsive, dependent. Distinguish from normal traits. Avoidant Personality Disorder: Inhibited, introverted, anxious. Fear of rejection, low self-esteem. Characteristics: avoidance, preoccupation with criticism/rejection, social ineptness. Treatment: Anti-anxiety drugs may help temporarily. Obsessive-Compulsive Personality Disorder: Perfectionism, inflexibility, diligence. Not OCD; need for control, not...
info_outline5.01 Ego Defenses
Psychiatry review for the USMLE Step 1 Exam
- Defense mechanisms protect the unconscious part of our personality from anxiety caused by unacceptable thoughts or feelings.
- Ego defenses are categorized into three groups: mature, neurotic, and immature.
- Immature defense mechanisms include projection, regression, denial, acting out, and splitting.
- Projection involves attributing objectionable thoughts or emotions to others.
- Regression is behaving in an age-inappropriate way to avoid tension associated with the current phase of development.
- Denial is not accepting or believing something to protect one's ego.
- Acting out involves giving in to socially inappropriate impulses to avoid anxiety.
- Splitting is viewing people as either all good or all bad, without considering the middle ground.
- Neurotic defense mechanisms include intellectualization, isolation of affect, displacement, rationalization, reaction formation, and repression.
- Intellectualization is overanalyzing situations or focusing on irrelevant details to avoid negative feelings.
- Isolation of affect is unconsciously limiting the experience of emotions associated with a stressful event.
- Displacement involves shifting emotions from one thing to another, which is deemed more acceptable.
- Rationalization is justifying one's behavior or negative feelings through rational explanations.
- Reaction formation is unconsciously acting opposite to an unacceptable impulse.
- Repression involves preventing thoughts or feelings from entering consciousness to avoid negative emotions.
- Mature defense mechanisms include humor, altruism, suppression, and sublimation.
- Humor is used to relieve anxiety and negative thoughts.
- Altruism involves performing beneficial acts for others to experience pleasure and relieve anxiety.
- Suppression is consciously blocking undesirable ideas, thoughts, or impulses.
- Sublimation is transforming anxiety or emotions into socially valued pursuits.
- Sublimation involves channeling negative emotions into productive and socially desirable actions.