TommyK HY 421-444

[Anonymous]

421
Dear Family,

Again, the below is not copyrighted and is original, but it will seem like an actual USMLE step 1 case you will see because it resembles the format of what they feel is important for you to know. Please study it because you will face the same format and "feel" again and again in similar concepts:

Case: A pediatric patient of yours named Valentine comes in with vague presentations involving sweating, poor feeding, respiratory issues, malaise, tantrums, trembling, confusion at times. History shows the following: Valentine has on your physical hepatomegaly, hyperlipidemia, and growth retardation, and his sugars are low.
(NOW, NBME USMLE STEP 1 cases can be VERY VERY LONG…do you know what this child has? If not, I need to give more information….)
More labs come back and you note that there is glycogen filling up in the body’s cells. Obtain a lipid profile. Modest elevations in very low-density lipoprotein cholesterol and triglyceride levels sometimes occur. Evaluate blood and urine for ketones, especially after a brief fast. Fasting ketosis is prominent.
(NOW, I believe here a well-prepared student should tell me the diagnosis…but remember, the USMLE is about secondaries to the disease, so here is the diagnosis and the relevant secondaries that are within the NBME sphere of focus)

Answers I am looking for:
1) The disease is of course Cori’s disease, a glycogen storage disease. (Incidentally, the husband and wife team won the Nobel Prize for their work)
2) If I asked what TYPE it is, you should tell me TYPE III. Don't confuse it with TYPE I or the others. There ARE clinical differences....
3) If I asked if gluconeogenesis is impaired, you should tell me that it is NOT IMPAIRED…a very common student mistake)
4) If I asked you the MOA, you should tell me that the debranching enzyme is deficient. REPEAT, DEBRANCHING ENZYME DEF.
5) If I asked you the enzyme itself which is a favorite on the NBME, you should tell me it is alpha 1,6 glucosidase (NOT beta 1,6 glucosidase, NOT alpha 1,4 glucosidase, NOT gamma 1,6 glucosidase, etc. which can be all in the answer choices)

Again the above is 100% made up by me and is property of ValueMD and even though it LOOKS like an actual NBME case, it is an original presentation and not a recall. But, I would not be surprised if it exists somewhere in the vaults of the NBME’s sphere of focus. This is just what I feel is a VERY VERY illustrative example of a “model” NBME USMLE Step 1 question. I feel I need to say this so that you all do not think I am violating copyright infringment, but rather educating in my own legal way.

Because the NBME also stresses PICTURES and TREATMENT and or DRUG, you should also know what the patient will present as and how you will treat them. THEN you may be asked what are the SIDE EFFECTS of the treatment and the long term consequences.

IT looks impossible, but it is just like remembering your aunt’s birthday…except of course you have like one million aunts. YOU can do it, my professional memory studies show most everyone can, but AT DIFFERENT SPEEDS. And you MUST HAVE THE RIGHT CONDITIONS AS I EXPLAINED BEFORE (NO 2 hour study days with the TV on, etc.)

Again, much love to you all,
Tommy
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422
This is not a case like the previous one but I think it is just as important to say:

1) You must understand how "to study" such vast material.

2) This is unlike recall only a pretty girl's telephone number. You must learn the material in LUMPS, so that is why my HYers are lumped. Again, to know what is purple, you must know what looks close..so you must know what black, blue, and deep green look like...

3) Repeat the information in GROUP in pre defined intervals.

4) KNOW the NBME wants you to get the COMPLETE picture. Anything goes.
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A reader just emailed me something that I MUST INCLUDE:

1) KNOW that the typical words presentations are being eliminated. For instance, for the dx POLYARTERITIS NODOSA, know that the words "cotton wool" spots will NOT be given, but the words will be described in detail in other less obvious or unique words.

2) Thus, buzzwords are becoming LESS AND LESS important. Ten years ago, when the USMLE STEP1 was a two day 700-750 question test, there were a lot of ONE LINERS, so BUZZWORDS WERE in vogue and used a lot. NOW, times have changed.

3) NOW, understand that VARIETY is flowing into the USMLE STEP 1. That means more diagrams, MRIs, pictures, photographs, CTs, flowcharts, biochemical pathways, and variable answer choices (not just A-E). My sources tell me the test is starting to "become alive" in a way.
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Sorry, this is not a case question but know this...

And I do not think the NBME will mind me telling you this...

USMLE STEP 2 materials are appearing in STEP 1!!!!!!!!!! Many many have told me that they had questions asking what is the best NEXT STEP in management of the patient. They could be theoretical questions...but really who knows!
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I just received another notice..seriously....from a student who took the STEP 1 and told me to rely this info to you.

Thus, I am making it a "concept" because it is so important...

The student came in the testing room and she was seated right next to the door. During one of the sections, there was talking outside by someone in the waiting area. Since she was SO SO nervous, it really hurt her, although she could not tell me if it messed up her questions, but she did think it may be slowed her down so she had to guess on the last question.

Q) So, what can you do about this?

A) Make sure they offer and make sure you wear your earplugs. I have heard of some students who are seated by the door that asked to be moved away and were granted their wish, but I am not sure about this because I have no proof. Don't underestimate this concept because if you are nervous, HAVE no earplugs, are seated next to the door and freaked out, that could be VERY BAD.
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Someone just keeps telling me test center advice...(I am going through my emails too).

BUT I AM INCLUDING THIS ONE BECAUSE I FEEL IT NEEDS TO BE A CONCEPT...

Bring two government IDs which your exact spelling on it. One of the students was PULLED OVER BY THE POLICE on the way to her testing center (maybe she did not know the way and made an illegal u turn or maybe she was speeding). But...listen...if you get caught by the police in your vehicle for speeding or something...in MANY of the USA states they WILL TAKE YOUR LICENSE ON THE SPOT, it is policy...the person who told me this lives in USA Chicago ILLINOIS. BE careful, but bring TWO government picture IDs. NBME centers will not let you take the test if you don't have pic ID! Then you will wail out in agony!!!!!!!!!!!!!!!
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Quickie case because people often get this confused!

LISTEN...the marker for Wegener's granulomatosis is C-ANCA. The marker for Polyarteritis nodosa is P-ANCA.

This IS a crucial fact even though it seems so small!!!!
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I don't think this is copyright infringement b/c I am describing what the NBME is asking you to understand, but here it is:

1) KNOW at least the very very simple basics of general chemistry and physics. Two of my students got these questions.

I cannot repeat the exact ones so I won't break copyright, but it had to do the delta G Energy stuff and enzymes for General Chemistry; and the PHYSICS questions had to do with LUNGS, gases kinetics; and another PHYSICS question had to do with flow equations and BLOOD VESSELS(remember the liquids and solids equations?)
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While we are on the subject, just for completion, I MUST SAY THIS:

ONE OF MY STUDENT TOLD ME HIS COMPUTER MALFUNCTIONED DURING HIS TEST! during his personal test day!!!

He said that he came out and the proctor told him that this never happened before on his watch, and then told him to call a place called CANDIDATE CARE and gave him a card.

I have NO IDEA what the computer problem was, or even if the student's problem was legitimate but I left the need to tell you what to do if such a crazy thing happens.

I was told that he was informed that he may get another testing day later, of course though he will not be charged as such.
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I learned this is VERY CRUCIAL:

Case: You open your door and in comes a guy like Beavis who asks you, a pathologist, to identify a bug on a slide from a patient with respiratory symptoms:

YOU see fungi appearing organisms. They have long branching filaments/rodlike structures under microscope. You are thinking MUCOR, but Gram stain produces gram positive rods.

Q) What bug is it? But the NBME will likely want you to tell the difference between it and another related morphological bug that is on the skin.

A) You are looking at NOCARDIA, an acid fast aerobe you can catch walking barefooted in soil. You can get respiratory symtpoms.
A2) Now the secondary is the bug ACTINOMYCES, a VERY common bug growing on your skin. It can infect the sinuses and is a gram positive anaerobe forming sulfa granules.

WOW, see how interesting this is?
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ALL NBME questions are noted by their test takers as being so VARIED...that is because of the sheer number of questions that they have and the number of people writing the questions.

SO, some of the questions will be very direct and SHORT.

AND others will be so LONG that you have to SCROLL down to read the entire QUESTION! Some questions I was told told seconds to answer, some took almost 6-7 minutes due to 20 different lab results they had to study!

That said, here is one:

ORIGINAL VALUE-MD CASE: A 16 year old patient named Thelma comes into your clinic with burns all over her body (1st and 2nd degree). After discussing with the family to rule out abuse (which you are required by law to do), you must start with what?

Ans1) IV fluids

Q2) Then, you note that her tetanus booster is two years ago, so what do you do?

A2) You do NOT have to give a booster, the time interval is 5 years...

Q3) What two main bugs if asked are you worried about initially?


A3) Pseudomonas of course and also Staphylococcus Aureus. (You must smell the wound site, if it smells "fruity" like grapes, Psudomonas is more likely).


Q4) So, the NBME and attending asks you what meds will you grab?

A4) You must grab 3 types: Morphine, NSAIDS, and an Antibiotic


Q5) Grab MORPHINE SULFATE FOR THE PAIN. But what do you be aware of before administering it?

A5) Ask her if she is taking MAOs for depression. Also, ask her about hypersensitivity and if she is pregnant because the respiratory DEPRESSION may hurt the baby.


Q6) After NSAIDS (no questions here) what two antibiotics are recommended typically today in the USA in this case (AND YOU MAY HAVE OTHER CHOICES ON THE TEST AND IN LIFE--this is ONLY A GUIDE BUT A USEFUL ONE)?

A6) Grab Silver Sulfadiazine and Neomycin. They should be good coverage. BUT, they are NOT the ONLY choices...so if on your test or in life you don't HAVE those choices, just pick the ones with Staph and anaerobic coverage!

See ya!
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This post has both answers to reader questions and a case:

Q) Why is FA not good enough for everything? And why is the students' mental processes in error? And what can be done?

A) Consider a classic case and question I posed to a group of my students: I asked, "IF YOU ARE ASKED ABOUT LESCH NYHAN DISEASE WHICH IS A NBME FAVORITE, TELL ME ALL YOU KNOW?" I presented a case with a boy in his teens with A HISTORY OF OCCASIONALLY FLANK PAIN!
Their response was the EXACT WORDING, "Self mutilation, Nail biting, Retardation." That was it. Then after waiting, one of them said, "HGPRT".

OK, but the NBME knows most med students are the best of the best and will know these 3 bits of info so you will likely NEVER see them. I remember one student told me that NBME presented the disease with a presentation that was close but not in those EXACT WORDS, (like nail biting). So, my QUESTION TO YOU is the following:


Q2) What is causing the flank pain?

A2) Kidney stones from excessive URIC ACID (that can be another question!)

Q3) You find out that he is on a thiazide diuretic medication for these kidney stones and a uricosuric called probenecid because his last doctor thought/heard that thiazide diuretic treat kidney stones and since uric acid is the problem, he gave him PROBENECID? Do you agree with his last doctor (hint: he was an inexperienced sub intern)?

A3) NO, he was wrong, the thiazides are contraindicated from Lesch Nyhan pts. and the uricosuric will only make stone formation WORSE.



Q4) Therefore, what do you change his meds to? And MOA of new drug please?


A4) He needs Allopurinol.


Q5) What ENZYME does allopurinol inhibit?

A5) It inhibits XANTHINE OXIDASE.


Q6) The NBME and USMLE give all the above in a case and then ask if anything else you should give him for prophylaxis that is NOT a prescribed drug? (VERY IMPORTANT)

A6) You MUST give him hydration.


Q7) If I gave you a picture of the brain on MRI with arrows, which structure is affected in this dx?

A7) Pick the arrow pointing to the basal ganglia.


Q The NBME and Attendings LOVE to asks this in mult choice form:
What is the genetics behind Lesch Nyhan?

A X linked recessive, so you mostly always see it in MALES. (although theoretically possibly presented in females which it has been reported, the NBME will not ask a bizarre EXCEPTION)


PLEASE PLEASE, use this and others as a MODEL for what you NEED TO KNOW. The one step questions like "What is the capital of New Jersey, USA?" Answer: "Trenton". They are GONE! (naturally, you won't be asked USA geography...but you need to get the concepts and THEORY)

Please keep asking me about BUZZWORDS. There are being slowly ELMINATED. IT does not mean you should forget all of them, because they may present the buzzword in OTHER COMMON words. But know this fact while you study!!

Did that answer your questions? (I am addressing my email question readers)
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"All USMLE cases are original and are expressly not from questions seen, recalled, paraphraphrased from the real USMLE, the material is for the purpose of the education of future physicians and the safety of their patients." This post has both answers to reader questions and a case:

Q) Why is FA not good enough for everything? And why is the students' mental processes in error? And what can be done?

A) Consider a classic case and question I posed to a group of my students: I asked, "IF YOU ARE ASKED ABOUT LESCH NYHAN DISEASE WHICH IS A NBME FAVORITE, TELL ME ALL YOU KNOW?" I presented a case with a boy in his teens with A HISTORY OF OCCASIONALLY FLANK PAIN!
Their response was the EXACT WORDING, "Self mutilation, Nail biting, Retardation." That was it. Then after waiting, one of them said, "HGPRT".

OK, but the NBME knows most med students are the best of the best and will know these 3 bits of info so you will likely NEVER see them. I remember one student told me that NBME presented the disease with a presentation that was close but not in those EXACT WORDS, (like nail biting). So, my QUESTION TO YOU is the following:


Q2) What is causing the flank pain?

A2) Kidney stones from excessive URIC ACID (that can be another question!)

Q3) You find out that he is on a thiazide diuretic medication for these kidney stones and a uricosuric called probenecid because his last doctor thought/heard that thiazide diuretic treat kidney stones and since uric acid is the problem, he gave him PROBENECID? Do you agree with his last doctor (hint: he was an inexperienced sub intern)?

A3) NO, he was wrong, the thiazides are contraindicated from Lesch Nyhan pts. and the uricosuric will only make stone formation WORSE.



Q4) Therefore, what do you change his meds to? And MOA of new drug please?


A4) He needs Allopurinol.


Q5) What ENZYME does allopurinol inhibit?

A5) It inhibits XANTHINE OXIDASE.


Q6) The NBME and USMLE give all the above in a case and then ask if anything else you should give him for prophylaxis that is NOT a prescribed drug? (VERY IMPORTANT)

A6) You MUST give him hydration.


Q7) If I gave you a picture of the brain on MRI with arrows, which structure is affected in this dx?

A7) Pick the arrow pointing to the basal ganglia.


Q The NBME and Attendings LOVE to asks this in mult choice form:
What is the genetics behind Lesch Nyhan?

A X linked recessive, so you mostly always see it in MALES. (although theoretically possibly presented in females which it has been reported, the NBME will not ask a bizarre EXCEPTION)


PLEASE PLEASE, use this and others as a MODEL for what you NEED TO KNOW. The one step questions like "What is the capital of New Jersey, USA?" Answer: "Trenton". They are GONE! (naturally, you won't be asked USA geography...but you need to get the concepts and THEORY)

Please keep asking me about BUZZWORDS. There are being slowly ELMINATED. IT does not mean you should forget all of them, because they may present the buzzword in OTHER COMMON words. But know this fact while you study!!

Did that answer your questions? (I am addressing my email question readers)
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Q) Key concept: An accident victim comes to your clinic named Louise. She has a hemoglobin level of 9. Your attending asks you if you will IMMEDIATELY transfuse. She is alert and oriented times 3.


A) NO, you transfuse usually in clinics (and boards) if the patient is showing clinical signs. Even if her Hemoglobin is low. BUT, that said, if her hemoglobin was under 7 (remember that number), then pick transfusion. I know I would....what do you guys think?
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Q) Case: This is a tough tough subject but a HY one: You have an older patient named Robert who comes to you with mild depression and dementia. (BE CAREFUL, DISTRACTORS ARE ALZHEIMER'S, etc.). But I tell you that during PE, I touched his facial nerve and it twitched. And his PE reveals some muscle spasms (tetany). HE also presents with mild KIDNEY disease....
So if I ask what mineral(mineral, specifically) is deficient which is specifically related to his tetany and presentation, which one will you PICK? What dx? (HINT: this is not dementia)

A) Calcium is deficient. Think of the link with the kidney and its regulation with Vit D which is needed for Ca. I saw this exact CASE during one of my on call nights!


Q2) What typical sign is found on ECG which confirms your suspicion?

A2) The QT interval is lengthened. This is CLASSIC..

(Again, CONCENTRATE ON THE FORMAT, of the above case and secondaries. These are NOT from Kaplan or NMS or big publishing house. They are from solely my experience as a teacher which I FIRMLY believe are better suited for you for STEP 1 and the clinics, because they do not go TOO light or TOO deep into the material...like the story of Goldilocks and the BEARS, the soup is just right. NOW STUDY STUDY STUDY STUDY, until you collapse!! Do it NOT for yourself, but for your future PATIENTS WHO NEED YOU!
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BIG POINT:

Case: A female pt of yours named Wilma comes in with vaginal bleeding with red lumps of cherries that are coming from her vagina. She believes she is pregnant from high HCG. BUT...I know you are NOT going to choose "abortion" as a choice because I am telling you that there are weird size and date assessement problems in history...
BUT, if you need more...the NBME and attendings will tell you that there is a BUZZWORD...a snow storm pattern on ultrasound and no fetus.

Q) NOW, you should tell me the dx, (IF you guessed it before the buzzword then you are doing great!)

Q2) Tell me the karyotype IF the mother's chromosomes contributed. HARD, but definitely NBME wants you to know.

Q3) What condition does she have PRIOR to her third trimester involving her BP?

Q4) Treatment Rx?

Q5) What dx can happen if you don't treat?

Q6) What enzyme does the drug I asked you for (which starts with the letter "M") act on?



A1) Hydatiform MOLE if only the father's genes came on board. It is called an incomplete mole if the mother contributes her genes and you will see fetal parts...

A2) 69 XXY, be careful, I asked you about the mom so this question addressed an INcomplete mole, not a hydatiform mole which is 46 XX...which only involved the father..

A3) Her BP is very high which is called "pre eclampsia". Which YOU MUST address promptly. If she is of right gestation, you must deliver...(This is a concept and question by ITSELF!!!!)

A4) Give methotrexate and monitor HCG after delivery until it goes to zero.

A5) Choriocarcinoma or INVASIVE MOLE!

A6) Methotrexate acts as you recall on my previous posts acts in the SYNTHESIS PHASE of the cell cycle and block DHFR or dihydrofolate reductase.

AGAIN, TO ADDRESS A READER QUESTION, PREVIOUS TEACHERS OR EXAMINEES ARE THE VERY BEST SOURCE OF QUESTIONS OF CONCEPTS FOR THE USMLE STEP 1. It takes a lot more work (I think I spent about 600-700 hours already), but YOU EXPERIENCED ONES ARE IN GREAT POSITION TO WRITE THE BEST POSSIBLE QUESTIONS SINCE YOU KNOW WHAT THE NBME NEEDS YOU TO MASTER, PLUS YOU HAVE CLINIC EXPERIENCE FROM ROTATIONS, and STEP 1 ADDRESSES A LOT OF 3rd YEAR CLINIC STUFF! JUST DON'T VIOLATE COPYRIGHT AND REPEAT EXACT QUESTIONS...think of the concepts and make up your OWN UNIQUE QUESTIONS, then the NBME will be HAPPY with our attempts!
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Copyrighted Original ValueMD Case:

Case: A patient walks into your clinic named Bruce and is a farmer's helper living in Indiana. He is asymptomatic but has an radiograph with a coin lesion (1 cm sized) that is calcified on a upper lung lobe. The lesion has not grown in 18 months (from his chart), and he has no PE symptoms otherwise. He is otherwise obeying HEALTHY habits (no drug use, smokies)
Q) What is the dx?



A) Because he lives in the Midwest USA, he likely has a benign granuloma from histoplasmosis since he also works on a farm. Since the lesion has not grown in 18 months, it is mostly likely NOT LUNG CANCER WHICH MUST BE RULED OUT AND YOUR ATTENDING WILL KNOCK YOU SILLY IF YOU MISS THIS AND HE the patient...DIES. The attending will lose his house, his car, and his friends.

Again, the clues that the lesion is only one cm. Second he has good health habits. Third, the lesion has not growth in 18 months and he has no other symptoms which pushes your thinking into a benign HISTO Ca lesion..

OK?
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Here we go again, today is Sunday, and church and prayer day. Now that I can take a quick break away from praying, here is a question:'

ValueMD copyright case: You are on a plane bound for Los Angeles to do a lung transplant. Sitting in the middle seat, you have two passengers sitting next to you. The man on the left Bob, excited he is sitting next to a budding doctor, asked you a couple of questions:

Q) "I just took these drug called Edrophonium because my IM doc wanted to see if I had a disease...I cannot recall the name, what is it?

A1) This short lasting drug is used for diagnosis of myathenia gravis.


Q2) Then Bob asks, "I ran out of meds and my friend gave me a drug called Bethanechol." He said it should work the exact same for my dx MOA. Is that true?

A2) NO! Bechanechol is ALSO a cholinomimetic, but HAS a different MOA. It is used often in OB patients for urinary retention, and it is a direct muscarinic agonist. His drug, Edrophonium is a CHOLINESTERASE INHIBITOR, and thus works indirectly by keeping ACh in the junction longer...


Q3) He pulls out a drug pharmacy box with a drug called Neostigmine, which his IM doc gave him. He then asked you the MOA exactly?

A3) This, like Edrophium, is a cholinesterase inhibitor. But it lasts longer so it is used for myasthenia gravis chronically. Its MOA is that it CARBAMYLATES cholinesterase at the NMJ, and causes the cholinesterase to stay inactive to HYRATION RXNS.


Q4) Then Bob asks you what would happen to his AV node in his heart in case he took the entire bottle by mistake?

A4) This class of drugs will have THE PARASYMPATHETIC EFFECTS at high doses. Remember the M2 receptors in the heart? (THEY WORK VIA a 7 MEMBRANE G COUPLED RECEPTOR that is INHIBITOR in this case. Second messengers are ADENYLATE CYCLASE WHICH HYPERPOLARIZE WITH POTASSIUM, then lowering cAMP, then PROTEIN KINASE A is lowered....DO YOU RECALL ALL THIS? Can you label all the protein enzymes in a blanked out flowchart? THIS IS A VERY VERY VERY IMPORTANT concept you cannot forget. Do you recall my mnemonic with the chip company AMD inhibiting dominant chipmaker Intel so letters A, M, D for the 2nd subtype of receptors as AMD is second to Intel are all working via the same MOA!)
So, the answer is that the velocity through the AV node will be reduced!!!

Q5) Next, Bill sitting to your right says that he was a FORMER PSYCHOTIC who overdosed with a D2 blocker drug and the ER have him PHYSOSTIGMINE. He asks you why couldn't he use Bob's drug NEOSTIGMINE?

A6) CRITICAL PT I mentioned long ago....PHYSOSTIGMINE can cross the all important Blood Brain Barrier and so is used for antimuscarinic cases of D2 antipsychotic drugs in the CNS...NEOSTIGIMINE CANNOT CROSS.

Q7) Then, he asks you how will he know if he took too much PHYSOSTIGMINE?

A7) Remember, lump stuff together. This is a cholinomimetic and will cause the associated symptoms which you MUST KNOW ALL OF THEM like miosis, it will make people feel like urinating, etc.


Q) Why then is Physostigmine more dangerous than Neostigmine? Think about it first...

A Because it can cross that Blood Brain Brain, an overdose will lead to respiratory depression and cardiac depression.

IF YOU REALLY UNDERSTOOD THE ABOVE CASE, YOU ARE DOING WELL!! Really focus on the words that I capitalize and know that you need to know EVERYTHING in detail. REREAD the above text over and over. I spent so much effort to give a NBME-philic case you can model your thinking around...

Tommy
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You know all about ATYPICAL PNEUMONIA from MYCOPLASMA pneumoniae right? But tell me three things quick!

1) Is the cough productive?

A1) NO


Q2) Are the antibody titers WARM OR COLD?


A2) They are positive COLD antibody titers.


Q3) Is the treatment Penicillin G or Penicillin V or NEITHER?

A4) This one needs a protein blockers like Erythromycin.
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You all know the most common primary bone tumor the NBME will ask is MULTIPLE MYELOMA.

Q) What is the 2nd most common primary bone tumor?




A) Osteogenic Sarcoma...do you know the age, and tx, and side effects??
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YOU all know that Glioblastoma Multiforme is an NMBE favorite and is the most common primary brain tumor in ADULTS.

Q) But is this the same in children?



A) NO! The most common primary brain tumor in kids is medulloblastoma. Could you point it out in an MRI? Do you know the Rx?
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Q) You know how to spot a clinical case of the CREST syndrome in a women right? First, think about it...Very important...when the labs come back, which autoantibody are you looking for?



A) The anti-centromere antibody.
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Q) We review a child with Celiac Disease and you KNOW who diet he must follow. Right now, as a review, tell me what lab antibody type are you looking for to confirm the diagnosis?


a) Antigliadin antibody
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Q) LUPUS in a women can be so devastating...

So tell me the two antibodies for SLE and THEN tell me the antibodies for SLE that was drug induced, and THEN tell me the drug which could have caused this crisis!



A) Naturally, you are looking for anti double stranded DNA and ANA antibodies (single stranded DNA antibodies are a common error) Also, you KNOW that my mnemonic is "Women have nice HIPPS." So...

H ydralazine
I zoniazid
P Phenytoin
P Procainamide

(Just for your info, know the commonest TRADE names for some of these drugs. I even heard LASIX is often substituted TOTALLY on the USMLE TESTS and in clinics for Furosemide. Just like KLEENEX (brand) is known better than tissue... and BAND AIDS (Brand name) is used more than "adhesive bandages". But these are exceptions...99% of the time the USMLE sticks to the generic names.
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