Verbatim Core Revision — Memory Armor

NRE Memory Master — Core

Every item taken verbatim from the core files — fact lines from the core master, topic lines from the Medical Lectures backbone. The scaffolding (trick + trap) is the only thing layered on top. 785 items across 47 sections, drilled in 133 pods of 7.
785verbatim items
47systems & packs
1337-item pods
561facts + 224 topics
THE 5-STEP RECITE PROTOCOL — how to burn these in
1
SCANRead the keywords. Say the answer aloud before peeking.
2
HOOKRead the trick aloud. Lock it onto the answer.
3
COVERCover the answers. Run the pod on keywords + tricks only.
4
CHECKUncover. Mark every miss. Name the trap you fell for.
5
SWEEPEnd of section: rerun your misses twice. Then move one pod forward.

THE SYSTEMS

CARDIOLOGY
19 items·3 pods
12Central crushing chest pain + ST elevation II,III,aVF
ANSWERINFERIOR MI → Reperfusion therapy
NUMBERII, III, aVF = the inferior floor — the lower wall lights up.
TRAPAnterior MI is V1-V4 territory, not II/III/aVF.
13Central crushing chest pain + ST elevation V1-V4
ANSWERANTERIOR MI (LAD occlusion) → Reperfusion
NUMBERV1-V4 = the front wall, LAD's own street — anterior MI is the LAD's signature.
TRAPInferior MI uses II/III/aVF; V1-V4 is LAD.
14Chest pain 1 year ago + dead inferior wall
ANSWERQ wave in II, III
PICTUREAn old inferior scar answers 'ever had a heart attack?' — the Q wave is the tombstone it left.
TRAPQ waves in other leads would point elsewhere; II/III/aVF = old inferior wall.
15Atrial fibrillation + cold pulseless painful limb
ANSWERACUTE ARTERIAL EMBOLISM → Embolectomy
CHAINAF + a dead limb = the clot that flew — embolism, and embolectomy is the evacuation.
TRAPAcute thrombosis in situ doesn't need AF to launch it.
16Sudden tearing chest pain to back + BP difference between arms
ANSWERAORTIC DISSECTION → IV beta blocker (NOT thrombolytics)
DANGERTearing pain to the back + BP difference = the aorta split — beta blocker, NEVER lyrics (thrombolytics).
TRAPThrombolytics in dissection = bleeding catastrophe.
17Aortic dissection + BP 210/120
ANSWERIV beta blocker (esmolol/labetalol)
DANGERThe dissecting aorta screaming at 210/120? Slow it, don't split it — esmolol/labetalol first.
TRAPNitroprusside alone lets reflex tachycardia tear more; beta comes first.
18Long-standing HTN + sudden tearing chest pain + false lumen on CT
ANSWERAORTIC DISSECTION
PICTUREFalse lumen on CT = the aorta's second barrel — dissection confirmed.
TRAPA true lumen-only scan isn't the dissection signature.
19Chest pain at rest + transient ST elevation + coronary vasospasm
ANSWERPRINZMETAL ANGINA → Nitrates + calcium channel blockers
SOUNDRest pain + transient ST elevation = the artery spasms — Prinzmetal. Give it a relaxer (nitrates/CCB).
TRAPBeta blockers can worsen spasm — the wrong relaxer.
20Chest pain within 1 hour + STEMI
ANSWERUrgent reperfusion (PCI or thrombolysis)
NUMBERWithin 1 hour = golden hour: open the artery. PCI or lyrics, fast.
TRAPWaiting past the window loses myocardium per minute.
21Chest pain + ST elevation + V1-V4
ANSWERLAD occlusion
NUMBERChest pain + ST elevation + V1-V4 → LAD occlusion — same front wall, same street.
TRAPV5-V6 would be circumflex territory.
22Symptomatic bradycardia
ANSWERIV atropine (first-line)
CHAINBradycardia → atropine — the vagal brake released, the pulse wakes up.
TRAPPacing first-line is wrong; atropine is the first move.
23Regular narrow-complex tachycardia 180 bpm
ANSWERVagal maneuvers (Valsalva) first
NUMBERNarrow-complex fast at 180 = SVT — first try the oldest trick: Valsalva.
TRAPAdenosine comes after vagal maneuvers fail.
24Acute coronary syndrome
ANSWERAspirin (irreversible COX-1 inhibitor, antiplatelet)
CHAINACS → aspirin, the one-way COX-1 plate killer — a single pill, irreversible platelet damage.
TRAPClopidogrel alone misses the immediate COX-1 punch.
25Cardiac troponin
ANSWERMost specific marker for MI within 6 hours
NUMBERTroponin = the most specific MI marker at 6 hours — the cardiac report card.
TRAPCK-MB rises earlier but is less specific.
26Heparin monitoring
ANSWERaPTT
ACRONYMHeparin → watch aPTT (intrinsic pathway alphabet: H-aPTT).
TRAPPT belongs to warfarin, the extrinsic pathway.
27Mitral stenosis
ANSWERMid-diastolic rumbling murmur + opening snap
SOUNDRumble + opening snap = the mitral door creaking — mid-diastolic, the blood's squeeze through.
TRAPSystolic murmurs point to the aortic door, not the mitral.
28Infective endocarditis + IV drug use + tricuspid valve vegetations
ANSWERIV drug use endocarditis
STORYIVDU + tricuspid vegetations = the needle's own endocarditis — right-sided, from the junkie's journey.
TRAPAortic vegetations in IVDU are the exception, not the classic.
29Heart failure + raised JVP + basal crackles
ANSWERPulmonary edema
CLINCHJVP up + crackles = the left pump failed — blood backs into the lungs: pulmonary edema.
TRAPRight-heart failure keeps lungs clear; this is the left side drowning.
30Pericardial effusion
ANSWERPericardiocentesis at LEFT 5TH intercostal space near sternum
NUMBERPericardial drain: left 5th intercostal space near the sternum — the safe window to the sac.
TRAP4th-5th midaxillary is the chest tube's triangle, not the paracentesis point.
ENDOCRINOLOGY
19 items·3 pods
36Weight gain + muscle weakness + purple striae + HTN + eosinopenia
ANSWERCUSHING SYNDROME
PICTUREStriae + weakness + HTN + eosinopenia = cortisol's stampede — Cushing.
TRAPAddison looks opposite: hyperpigmented, low pressure.
37Hyperpigmentation + hyponatremia + hyperkalemia + weight loss
ANSWERADDISON DISEASE
CLINCHHyperpigmentation + low Na + high K = adrenal gone quiet — Addison's pigment and electrolytes.
TRAPCushing is the mirror: striae, high BP, eosinopenia.
38Obese female 50yo + polyuria/polydipsia/polyphagia + glucose 170
ANSWERTYPE 2 DM → Metformin first-line
NUMBERObese 50yo + the three polias + glucose 170 = Type 2, metformin first.
TRAPGlucose under 200 with classic risk → T2DM lane, not DKA.
39Obese female + polyuria/polydipsia/polyphagia
ANSWERType 2 DM → Metformin (decreases hepatic glucose production)
CHAINSame obese polia story — metformin brakes the liver's glucose tap.
TRAPInsulin first-line in T2DM is wrong; metformin is the starter.
40T1DM + abdominal pain + vomiting + deep rapid breathing + glucose 480 + ketones +
ANSWERDKA → IV insulin + IV fluids
DANGERT1DM + deep rapid breathing + ketones + glucose 480 = DKA — the acid storm. Fluids + insulin.
TRAPHHNK has high glucose without heavy ketones or deep Kussmaul.
41Diabetic + missed insulin
ANSWERPalpitations, breathlessness, nausea → HYPOKALEMIA (insulin drives K+ into cells)
DANGERMissed insulin + palpitations/breathlessness = K+ driven into cells — hypokalemia's masquerade.
TRAPHyperglycemia alone doesn't give this triad; low K does.
42Diabetic + recent insulin therapy + missed doses + palpitations/breathlessness
ANSWERHypokalemia
CHAINInsulin therapy + missed doses + palpitations → hypokalemia — the shift, not the shortage.
TRAPHypoglycemia would bring sweating and confusion, not breathlessness first.
43Hyperthyroid + tachycardia/SOB/chest pain
ANSWERPROPRANOLOL (beta blocker for symptoms)
CHAINHyperthyroid + racing heart → propranolol — calm the symptoms while the gland gets treated.
TRAPBeta blocker is symptom control, not cure — the gland still needs therapy.
44Hyperthyroidism most common cause worldwide
ANSWERGRAVES DISEASE
CLINCHWorldwide, hyperthyroidism's most common name is Graves.
TRAPToxic nodule is regional, not the worldwide king.
45Hyperthyroid in pregnancy safest
ANSWERPTU (propylthiouracil)
ACRONYMPregnant + hyperthyroid → PTU — the trimester-safe pick.
TRAPMethimazole risks embryopathy early in pregnancy.
46Solitary thyroid nodule + FNAC papillary carcinoma
ANSWERTotal thyroidectomy
DANGERSolitary nodule + FNAC papillary → take the thyroid out — total thyroidectomy.
TRAPLobectomy alone risks leaving the cancer's cohort.
47MEN 2A + thyroid lump + diarrhea
ANSWERMEDULLARY CARCINOMA of thyroid
CLINCHMEN 2A + lump + diarrhea = medullary — the C-cell cancer with the gut shout.
TRAPPapillary doesn't come with MEN 2A + diarrhea.
48Post-thyroidectomy + perioral numbness + Chvostek sign
ANSWERHYPOCALCEMIA
CHAINPost-thyroidectomy + perioral numb + Chvostek = parathyroids nicked — calcium down.
TRAPHoarseness is nerve, not calcium; Chvostek is the hypocalcemic tell.
49Singer + thyroid surgery
ANSWERRisk of hoarseness (recurrent laryngeal nerve)
PICTURESinger + thyroid surgery = the recurrent laryngeal nerve — the voice's wire.
TRAPThe external branch affects only pitch; the recurrent one owns the voice.
50Pheochromocytoma + paroxysmal HTN/headache/tremor
ANSWERDiagnostic test: METANEPHRINES
ACRONYMPheo + paroxysmal HTN + headache + tremor → metanephrines — the tumor's calling card.
TRAPVMA is older and less specific; metanephrines are the test.
51Pheochromocytoma
ANSWERPre-op: alpha-blockade FIRST, THEN beta-blockade
DANGERPheo pre-op: alpha FIRST, beta second — never reverse, or the unopposed alpha spikes.
TRAPBeta-first in pheo = hypertensive crisis from unopposed alpha.
52HbA1c
ANSWERAverage glucose control over 2-3 months
NUMBERHbA1c = the 2-3 month glucose album — averaging the sugars you survived.
TRAPFasting glucose is a snapshot; HbA1c is the season.
53Metformin mechanism
ANSWERDecreases hepatic glucose production
CLINCHMetformin → the liver's gluconeogenesis mute button.
TRAPSulfonylureas stimulate insulin; metformin cuts production.
54Thiazolidinediones
ANSWERPPAR-gamma agonists (increase insulin sensitivity)
SOUNDGlitazones = PPAR-gamma, the cells' 'listen to insulin' amplifier.
TRAPThey don't secrete insulin; they sensitize — that's the whole point.
INFECTIOUS DISEASE / SEPSIS
31 items·5 pods
60Fever + tachycardia + hypotension + source
ANSWERSEPSIS → Cultures → Abx within 1 hour → Fluids 30 mL/kg
NUMBERSepsis: cultures → antibiotics within 1 hour → fluids 30 mL/kg — the first-hour triple.
TRAPWaiting for cultures before antibiotics costs lives; they run together.
61Hypotension + lactate >2 despite fluids
ANSWERSEPTIC SHOCK → Norepinephrine (NOT dopamine)
CHAINHypotension + lactate >2 after fluids = septic shock → norepinephrine, not the old dopamine reflex.
TRAPDopamine is second-line; norepi is the pressor of the septic decade.
62Septic shock + warm flushed skin + high cardiac output + low SVR
ANSWERTNF-alpha plays major role
CLINCHWarm flushed skin + high output + low SVR = TNF-alpha's cytokine party — the warm shock blush.
TRAPCold clammy shock is the late decompensation, different mediator story.
63Septic shock + DIC (prolonged PT/INR, low platelets)
ANSWERTreat sepsis + supportive
DANGERSeptic shock + DIC = treat the sepsis; the coagulopathy follows the infection's lead.
TRAPReplacing blood products blindly while sepsis rages ignores the driver.
64Meningococcal meningitis + fever + hypotension + purpuric rash
ANSWERIV ceftriaxone (immediate)
DANGERMeningococcal + purpuric rash = the bloodstream's emergency — ceftriaxone immediately, before CT.
TRAPWaiting for LP before antibiotics in meningococcemia is deadly.
65Bacterial meningitis + fever + neck stiffness + photophobia + Kernig
ANSWERCSF: low glucose, high protein, turbid, neutrophils
CHAINBacterial meningitis CSF: low glucose, high protein, turbid, neutrophils — the purulent signature.
TRAPViral meningitis flips it: lymphocytes, normal glucose.
66Fever + neck stiffness + purpuric rash
ANSWERCSF: LOW glucose, HIGH protein, turbid
CLINCHNeck stiffness + purpuric rash = same CSF story: LOW glucose, HIGH protein, turbid.
TRAPClear CSF with lymphocytes points viral, not bacterial.
67Bacterial meningitis (child) + CSF neutrophilic predominance + low glucose
ANSWERBacterial meningitis
CHAINChild + neutrophilic CSF + low glucose = bacterial — neutrophils are the bacterial flag.
TRAPLymphocytic predominance sends you the viral way.
68Worst headache of my life + neck stiffness
ANSWERSUBARACHNOID HEMORRHAGE
DANGER'Worst headache of my life' = the thunderclap — subarachnoid hemorrhage until proven.
TRAPMigraine doesn't call itself 'worst ever' with neck stiffness.
69SAH + ruptured berry aneurysm
ANSWERNimodipine (prevents vasospasm)
SOUNDSAH + berry aneurysm → nimodipine — the vasospasm shield for the brain's arteries.
TRAPCalcium blockers for BP here won't prevent the spasm; nimodipine does.
70Berry aneurysm most common site
ANSWERANTERIOR COMMUNICATING artery
CLINCHBerry aneurysm's favorite seat = the anterior communicating artery — the junction's weak link.
TRAPMiddle cerebral is common but not the 'most common berry' answer.
71Community acquired pneumonia most common
ANSWERSTREP PNEUMONIAE
CLINCHCAP's usual guest = Strep pneumoniae — the lobar consolidator.
TRAPAtypicals are the variation, not the theme.
72Post-splenectomy + fever + rusty sputum + consolidation
ANSWERStrep pneumoniae (lancet-shaped, alpha-hemolytic, catalase-negative, gram-positive)
CHAINPost-splenectomy + rusty sputum = Strep pneumoniae — the capsule's kingdom, now unguarded (alpha-hemolytic, catalase-negative).
TRAPH. flu post-splenectomy happens but Strep is the classic rusty-sputum player.
73Dengue + fever + retro-orbital headache + joint/muscle aches + travel
ANSWERDENGUE
PICTURERetro-orbital headache + joint/muscle aches + travel = dengue's bone-crushing bow.
TRAPSimple viral flu doesn't give retro-orbital pain as its tell.
74Malaria + travel + cyclical fever
ANSWERThick and thin blood film (best initial test)
CHAINMalaria + cyclical fever → thick + thin blood film — see the parasite, don't guess it.
TRAPRDTs are adjuncts; the film is the best initial answer.
75Malaria falciparum
ANSWERACT (artemisinin-based combination therapy) → Reduces parasite resistance
ACRONYMFalciparum → ACT — artemisinin + partner = resistance's enemy.
TRAPArtemisinin monotherapy breeds resistance; ACT pairs it.
76Falciparum malaria + ACT
ANSWERAdvantage: reduces resistance
CLINCHACT's advantage: the partner drug shields artemisinin — resistance lost its runway.
TRAPSingle-agent therapy is exactly what creates resistance.
77HIV/AIDS + dark pigmented plaques
ANSWERKAPOSI SARCOMA
PICTUREHIV + dark pigmented plaques = Kaposi — HHV-8's skin signature.
TRAPBasal cell doesn't bloom like this in HIV; Kaposi is the AIDS-era tell.
78C. difficile + post-antibiotic watery diarrhea
ANSWEROral vancomycin (first-line)
CHAINC. diff post-antibiotic diarrhea → oral vancomycin — the gut's targeted clean-up.
TRAPMetronidazole is the step down; vancomycin leads now.
79Dog bite + unvaccinated
ANSWERRabies vaccine + rabies immunoglobulin
DANGERDog bite + unvaccinated → rabies vaccine + immunoglobulin — the twin defense.
TRAPVaccine alone leaves the virus a window; IG closes it.
80Dog bite + bleeding bites
ANSWERRabies vaccine + rabies immunoglobulin
DANGERBleeding bites = the rabies risk escalator — vaccine + IG, no shortcuts.
TRAPTetanus shot is needed too but rabies IG is the bite's other half.
81Dog bite (unvaccinated hunter)
ANSWERVaccine + rabies immunoglobulin
CLINCHUnvaccinated hunter + dog bite → vaccine + IG — same rule, wilder risk.
TRAPObservation without IG when unvaccinated is gambling with rabies.
82Hepatitis B vaccine
ANSWERAnti-HBsAg detectable from vaccination alone
CHAINVaccine = anti-HBsAg rises alone; the core antibody never shows from vaccination.
TRAPAnti-HBc positivity means natural infection, not the shot.
83HBsAg positive mother
ANSWERHBIG + HBV vaccine to newborn within 12-24 hours
NUMBERHBsAg-positive mother → HBIG + vaccine to newborn within 12-24 hours — the window closes fast.
TRAPVaccine alone at birth may be too slow against vertical transmission.
84Hepatitis B + pregnant + HBIG given
ANSWERThen HBV vaccine 1st dose within 12-24 hours
NUMBERHBIG given → the vaccine's first dose follows within 12-24 hours — passive then active.
TRAPDelay beyond 24 hours risks the hepatitis escape.
85Most common acute hepatitis in children
ANSWERHEPATITIS A
CLINCHChildren's most common acute hepatitis = A — the fecal-oral crowd favorite.
TRAPHepatitis B in kids is a vertical story, not the most common acute.
86UTI most common organism
ANSWERE. COLI
CLINCHUTI's organism = E. coli — the perineal colonizer's climb.
TRAPStaph is skin; E. coli owns the urinary tract.
87UTI + burning micturition + nitrites positive
ANSWERE. COLI
CHAINBurning micturition + nitrites + = E. coli — nitrites are its nitrate-reducing flag.
TRAPEnterococcus doesn't reduce nitrate; the nitrite-negative UTI is its hint.
88Osteomyelitis in sickle cell disease most common
ANSWERSALMONELLA
CLINCHSickle cell + osteomyelitis = Salmonella — the sickle's unusual suspect.
TRAPStaph is usual osteo; sickle flips the odds to Salmonella.
89Neonatal sepsis most common cause
ANSWERGROUP B STREPTOCOCCUS
ACRONYMNeonatal sepsis's king = Group B strep — the birth canal's colonizer.
TRAPE. coli is late-onset's player; GBS owns early sepsis.
90Strep throat + strawberry tongue + sandpaper rash
ANSWERGROUP A STREP (S. pyogenes)
PICTUREStrawberry tongue + sandpaper rash = Group A strep's scarlet theater.
TRAPViral exanthems don't give the strawberry tongue.
NEPHROLOGY / ELECTROLYTES
13 items·2 pods
96Periorbital edema + cola-colored urine + sore throat 2 weeks ago
ANSWERPSGN (post-streptococcal GN)
NUMBERPeriorbital edema + cola urine + sore throat 2 weeks ago = PSGN — the strep's immune echo, 2 weeks later.
TRAPIgA nephropathy strikes in 1-2 DAYS, not 2 weeks.
97Generalized edema + dark scanty urine + sore throat 2 weeks ago + BP 130/90
ANSWERPSGN
CLINCHScanty dark urine + sore throat 2 weeks back + BP up = PSGN again — the post-strep glomerular stamp.
TRAPNephrotic would say protein +++ and puffy everywhere, not cola + BP.
98Periorbital puffiness + edema + ascites + urine protein +++
ANSWERNEPHROTIC SYNDROME
CLINCHEdema + ascites + protein +++ = nephrotic — the sieve leaks protein.
TRAPPSGN is nephritic: blood in urine, high BP, less protein.
99Painless hematuria within 1-2 days of URTI
ANSWERIgA NEPHROPATHY (most common glomerulonephritis worldwide)
NUMBERHematuria 1-2 days after URTI = IgA — the cold's same-week blood.
TRAPPSGN waits 2 weeks; IgA hurries in days.
100Hemoptysis + hematuria + crepitations
ANSWERGOODPASTURE SYNDROME
STORYHemoptysis + hematuria + crepitations = Goodpasture — anti-GBM attacks lung and kidney.
TRAPWegener also bleeds, but anti-GBM's dual hit is the Goodpasture answer.
101Severe hyperkalemia + ECG peaked T waves
ANSWERIV calcium gluconate (stabilizes myocardium FIRST)
DANGERSevere hyperK + peaked T = protect the MYOCARDIUM FIRST with IV calcium gluconate — stabilize before you shift.
TRAPInsulin/glucose shifts K but doesn't stabilize the heart first.
102Hyperkalemia ECG
ANSWERTALL PEAKED T waves
PICTURETall peaked T waves = hyperkalemia's ECG flag — the mountain on the tracing.
TRAPU waves point hypokalemia, the valley.
103Hyperkalemia complication
ANSWERCARDIAC ARREST
DANGERHyperkalemia's killer ending = cardiac arrest — the ECG goes beyond peaked T.
TRAPIt's not renal failure itself; it's the arrest arrhythmia.
104Primary hyperaldosteronism (Conn syndrome)
ANSWERHypernatremia + hypokalemia
ACRONYMConn = aldosterone storm: high Na, low K — the hypertensive with the potassium leak.
TRAPCushing gives high BP too but not this Na/K polarity.
105Chronic kidney disease + anemia
ANSWERErythropoietin deficiency (primary cause)
CHAINCKD + anemia = erythropoietin deficiency — the kidney's EPO factory went dark.
TRAPIron deficiency can coexist, but EPO loss is the primary CKD anemia.
106Chronic renal failure + bone pain + fractures
ANSWERSecondary hyperparathyroidism
CHAINCRF + bone pain + fractures = secondary hyperparathyroidism — the phosphate/calcium seesaw tips.
TRAPPrimary hyperPTH would have the gland's own adenoma story, not CRF.
107Hypertensive diabetic + persistent proteinuria
ANSWERACE inhibitor (enalapril) — renal protective
ACRONYMHypertensive diabetic + persistent proteinuria → ACE inhibitor — the kidney's protective shield.
TRAPBeta blockers lower BP but don't hold the renal protection title.
108Most reliable urine specimen
ANSWERMIDSTREAM voiding
CLINCHMost reliable urine specimen = midstream voiding — the flow washes the urethra first.
TRAPFirst-catch is urethral; midstream is the kidney's clean sample.
GASTROENTEROLOGY / HEPATOLOGY
33 items·5 pods
114Severe epigastric pain radiating to back + vomiting + raised amylase/lipase
ANSWERACUTE PANCREATITIS
CHAINEpigastric pain through to the back + raised amylase/lipase = acute pancreatitis — the pancreas's own fire.
TRAPBiliary colic doesn't radiate to the back with raised lipase.
115Pancreatitis + steatorrhea
ANSWERLIPASE deficiency is cause
CLINCHPancreatitis + steatorrhea = lipase deficiency — fat's undigested sludge in stool.
TRAPAmylase deficiency doesn't cause steatorrhea; lipase does.
116Alcohol abuse + pancreatitis + steatorrhea + raised amylase/lipase
ANSWERDecreased lipase
CHAINAlcohol + pancreatitis + steatorrhea = decreased lipase — the damaged acinar cell's output drops.
TRAPAmylase may be normal; lipase is the steatorrhea's keeper.
117Chronic alcoholic + recurrent epigastric pain + pancreatic calcification
ANSWERCHRONIC PANCREATITIS
PICTUREChronic alcoholic + epigastric pain + pancreatic calcification = chronic pancreatitis — the calcified scar.
TRAPAcute pancreatitis doesn't calcify on background of alcohol.
118Pancreatic pseudocyst + history of acute pancreatitis 6 weeks ago
ANSWERPseudocyst
NUMBERPseudocyst + acute pancreatitis 6 weeks ago = the pancreas's water balloon, matured.
TRAPAcute fluid collection can't call itself pseudocyst at week 1-2.
119Epigastric mass + history of acute pancreatitis 6 weeks ago
ANSWERPANCREATIC PSEUDOCYST
CLINCHEpigastric mass + pancreatitis 6 weeks back = the pancreatic pseudocyst — the walled-off cyst.
TRAPA pancreatic cancer mass doesn't follow an acute pancreatitis 6 weeks before.
120Air under diaphragm on erect CXR
ANSWERPERFORATED PEPTIC ULCER → Emergency laparotomy
DANGERAir under the diaphragm = the gut's hole — perforated peptic ulcer → emergency laparotomy.
TRAPFree air on plain film is the perforation's X-ray verdict.
121Sudden generalized severe abdominal pain + rigid abdomen + guarding + free air
ANSWERPerforated peptic ulcer → Emergency laparotomy
DANGERRigid abdomen + guarding + free air = perforation → laparotomy — the board-hard belly.
TRAPPancreatitis is tender but not board-rigid with free air.
122Alcohol abuse + hematemesis + spider naevi + caput medusae
ANSWERESOPHAGEAL VARICES
PICTUREAlcohol + hematemesis + spider naevi + caput medusae = esophageal varices — portal hypertension's burst pipes.
TRAPPeptic ulcer bleeds don't carry caput medusae.
123Cirrhosis + hematemesis
ANSWEREsophageal varices → Octreotide (reduces portal pressure)
CHAINCirrhosis + hematemesis → varices → octreotide — squeeze the splanchnic flow.
TRAPPPI doesn't lower portal pressure; octreotide does.
124Bleeding esophageal varices + cirrhosis
ANSWEROctreotide (immediate)
DANGERBleeding varices → octreotide immediately — the portal pressure brake.
TRAPEndoscopy is coming, but octreotide starts now.
125Cirrhosis + confusion + asterixis + hyperammonemia
ANSWERHEPATIC ENCEPHALOPATHY (ammonia)
CHAINCirrhosis + confusion + asterixis + high ammonia = hepatic encephalopathy — the liver's detox failed.
TRAPWernicke has ataxia + ophthalmoplegia; this is the ammonia story.
126Ammonia metabolized in liver by binding to
ANSWERGLUTAMATE
CLINCHAmmonia in liver binds to glutamate — the detox taxi.
TRAPUrea cycle is the final road; glutamate is where ammonia first hops.
127Hematemesis + cirrhosis + portal hypertension
ANSWEREsophageal varices (urgent)
CLINCHHematemesis + cirrhosis + portal HTN = varices — the portal system's bleeding signature.
TRAPMallory-Weiss tears don't need cirrhosis.
128Dysphagia progressive (solids then liquids) + weight loss + lower esophageal
ANSWERESOPHAGEAL CARCINOMA → Esophagectomy
DANGERProgressive dysphagia solids→liquids + weight loss = esophageal carcinoma → esophagectomy.
TRAPAchalasia fails to relax but doesn't cause the weight-loss cachexia of cancer.
129Dysphagia to both solids and liquids + LES fails to relax + lack of peristalsis
ANSWERACHALASIA CARDIA
SOUNDDysphagia solids AND liquids + LES fails to relax + no peristalsis = achalasia — the door that won't open.
TRAPPeptic stricture starts solids only, no LES failure.
130Barium swallow + bird beak + air-fluid level + dysphagia
ANSWERAchalasia cardia
PICTUREBarium swallow + bird beak = achalasia's X-ray monogram — the narrowed distal esophagus.
TRAPCarcinoma would show an irregular rat-tail, not a clean beak.
131Hematemesis + chronic liver disease
ANSWEREsophageal varices
CLINCHHematemesis + chronic liver disease = varices — the hepatocellular backdoor bleeds.
TRAPGastritis is possible but liver disease reroutes the answer to varices.
132Melena + duodenal ulcer + H. pylori CLO positive
ANSWERTriple therapy: PPI + amoxicillin + clarithromycin
ACRONYMMelena + DU + H. pylori CLO + = triple therapy: PPI + amoxicillin + clarithromycin — the eradication trio.
TRAPPPI alone heals but the bug returns; the trio eradicates.
133H. pylori eradication
ANSWERUrea breath test (non-invasive follow-up)
CLINCHH. pylori eradication follow-up = urea breath test — breathe out the infection's verdict (non-invasive).
TRAPEndoscopic biopsy is invasive; urea breath is the non-invasive follow-up.
134Recurrent abdominal pain + improves with defecation + stress + normal investigations
ANSWERIBS
ACRONYMRecurrent abdominal pain + better after defecation + stress + normal investigations = IBS — the gut-brain dialogue.
TRAPIBD shows inflammation on scope; IBS is clean.
135Barrett's esophagus (squamous to columnar)
ANSWERMETAPLASIA
CLINCHBarrett = squamous → columnar — the esophagus adapts to acid as metaplasia.
TRAPDysplasia is the next step, but this line asks the change name: metaplasia.
136Colicky pain + vomiting + distension + constipation + air-fluid levels
ANSWERINTESTINAL OBSTRUCTION → NG decompression + IV fluids
PICTUREColicky pain + vomiting + distension + constipation + air-fluid levels = intestinal obstruction → NG decompression + IV fluids.
TRAPPerforation shows free air; obstruction shows air-fluid levels.
137Bowel obstruction most common cause in adults
ANSWERPOSTOPERATIVE ADHESIONS
CLINCHAdult obstruction's most common cause = postoperative adhesions — the scar tissue snare.
TRAPHernias lead in some lists, but surgical history tilts it to adhesions.
138Right colon cancer
ANSWERRIGHT HEMICOLECTOMY
CHAINRight colon cancer → RIGHT hemicolectomy — the anatomy decides the surgery.
TRAPLeft colon cancer takes a left hemicolectomy; the side matters.
139Blood in stool + positive FOBT
ANSWERColonoscopy
CHAINBlood in stool + positive FOBT → colonoscopy — the scope's the next stop.
TRAPRepeat FOBT wastes the positive signal.
140Rectal bleeding + tenesmus + low rectal mass
ANSWERColonoscopy with biopsy
CHAINRectal bleeding + tenesmus + low rectal mass → colonoscopy with biopsy — the low-growth tissue sample.
TRAPDigital exam finds it, but the answer wants the scope + tissue.
141Rectal mass + weight loss + change in bowel habits
ANSWERColonoscopy with biopsy
DANGERRectal mass + weight loss + bowel habit change → colonoscopy with biopsy — cancer until proven.
TRAPHemorrhoids don't cause weight loss.
142Colorectal cancer screening
ANSWERStart at age 45-50
NUMBERColorectal screening starts 45-50 — the decade that saves.
TRAPScreening at 60 misses the preventable window.
143Polyp most likely malignant
ANSWERVILLOUS ADENOMATOUS
CLINCHPolyp most likely malignant = villous adenomatous — the sessile villous troublemaker.
TRAPTubular adenomas are the common but less nasty cousin.
144Upper GI bleeding investigation of choice
ANSWERUpper GI endoscopy
CHAINUGIB investigation of choice = upper GI endoscopy — see the bleeder, treat the bleeder.
TRAPAngiography is when endoscopy can't localize or control.
145Liver abscess + tender + fever + sweating
ANSWERUltrasound-guided aspiration
CHAINLiver abscess + tender + fever + sweating → ultrasound-guided aspiration — drain the pus pocket.
TRAPAntibiotics alone without drainage risks the abscess's persistence.
146Steatorrhea + pancreatitis
ANSWERLipase deficiency
CLINCHSteatorrhea + pancreatitis = lipase deficiency — the fat-digesting enzyme's absence.
TRAPAmylase is starch; lipase is fat.
HEMATOLOGY
17 items·3 pods
152Pallor + bone pain + bruising + WBC 42k + 85% immature granulocytes + normal 3 months ago
ANSWERACUTE MYELOID LEUKEMIA (AML)
NUMBERPallor + bone pain + bruising + 42k WBC + 85% immature granulocytes = AML — the marrow's coup, blasts in charge.
TRAPCLL is the elderly lymphocytosis, no 85% blasts.
153Fever + anemia + abdominal pain + gum hyperplasia + blasts + Auer rods + MPO positive + WBC 42k
ANSWERAML
PICTUREFever + gum hyperplasia + Auer rods + MPO + = AML — the myeloblast's calling card (Auer rods).
TRAPALL has no Auer rods and no MPO.
154Autoimmune hemolytic anemia + positive Coombs test
ANSWERTYPE II HYPERSENSITIVITY (antibody-mediated)
NUMBERAutoimmune hemolytic anemia + Coombs + = Type II hypersensitivity — antibody attacks its own red cells.
TRAPType III is immune-complex; this is direct cell attack.
155Megaloblastic anemia + neurological symptoms (SCD)
ANSWERVITAMIN B12 deficiency
CHAINMegaloblastic anemia + neuro symptoms (SCD) = B12 deficiency — the cord suffers with the blood.
TRAPFolate fixes blood alone and masks the neuro damage.
156Fatigue + microcytic hypochromic + chronic iron deficiency
ANSWEROral iron therapy (first-line)
CHAINFatigue + microcytic hypochromic + iron deficiency → oral iron first-line — refill the store.
TRAPIV iron is the special case; oral is the first line.
157Iron deficiency + menorrhagia
ANSWEROral iron therapy
CLINCHIron deficiency + menorrhagia → oral iron — the monthly leak's repair.
TRAPTransfuse only in severe anemia; oral iron is the routine.
158Hemoglobin primary function
ANSWEROXYGEN TRANSPORT
CLINCHHemoglobin's primary function = oxygen transport — the red cell's raison d'être.
TRAPCO2 carriage is secondary, not the primary function.
159Thalassemia major + multiple transfusions + leg edema + dyspnea
ANSWERDILATED CARDIOMYOPATHY (iron overload)
CHAINThalassemia major + multiple transfusions + edema + dyspnea = dilated cardiomyopathy from iron overload — the transfused heart.
TRAPRestrictive cardiomyopathy from iron is the wrong pattern; it's dilated.
160Neonatal jaundice within 24 hours + mother Rh-negative + baby Rh-positive
ANSWERHEMOLYTIC DISEASE OF NEWBORN
ACRONYMRh-neg mother + Rh-pos baby + jaundice in 24h = hemolytic disease of newborn — Rh war, day one.
TRAPABO disease is milder and rarely first-day severe.
161Hemolysis in neonatal hyperbilirubinemia
ANSWERIncreased UNCONJUGATED bilirubin
CLINCHNeonatal hemolysis → increased UNCONJUGATED bilirubin — the unprocessed pigment.
TRAPConjugated rises when the liver can't excrete, not from hemolysis.
162G6PD deficiency + oxidant drugs + Heinz bodies
ANSWERG6PD deficiency (X-linked)
CHAING6PD + oxidant drugs + Heinz bodies — X-linked, the boys' enzyme hole.
TRAPSickle is sickled cells on smear, not Heinz bodies after oxidants.
163Mismatched blood transfusion + acute hemolysis
ANSWERCOMPLEMENT activation
DANGERMismatched transfusion + acute hemolysis = complement activation — the membrane attack.
TRAPDelayed reactions are antibody-mediated without the acute complement storm.
164Blood transfusion reaction + fever/chills/rigors/SOB
ANSWERStop transfusion → Steroid + antihistamine
DANGERTransfusion reaction + fever/chills/SOB → STOP transfusion → steroid + antihistamine — stop the assault.
TRAPContinuing the bag while treating the reaction is the classic lethal error.
165Insulin most common side effect
ANSWERHYPOGLYCEMIA
CLINCHInsulin's most common side effect = hypoglycemia — the drug's job overshot.
TRAPWeight gain is chronic; hypoglycemia is the acute common one.
166TTP most common cause of death
ANSWERINTRACRANIAL HEMORRHAGE
DANGERTTP's most common cause of death = intracranial hemorrhage — the low-platelet bleed in the brain.
TRAPRenal failure is a feature, but the bleed is the killer.
167Warfarin overdose + nosebleeds
ANSWERVitamin K (antidote)
CHAINWarfarin overdose + nosebleeds → vitamin K — the antidote that restarts clotting.
TRAPProtamine reverses heparin, not warfarin.
168Heparin monitoring
ANSWERaPTT
ACRONYMHeparin monitoring → aPTT — the intrinsic pathway's clock.
TRAPPT/INR monitors warfarin.
NEUROLOGY
37 items·6 pods
174Sudden weakness + aphasia within 2 hours + CT no hemorrhage
ANSWERISCHEMIC STROKE → IV thrombolysis
DANGERWeakness + aphasia within 2 hours + CT clear of blood = ischemic stroke → IV thrombolysis — time is brain.
TRAPHemorrhagic stroke on CT forbids thrombolysis.
175Weakness + aphasia + 4 hours + CT normal
ANSWERIschemic stroke (IV thrombolysis if within window)
NUMBER4 hours + CT normal = still in the thrombolysis window — the clock matters more than the minutes' fear.
TRAPBeyond 4.5h the lytic risk outweighs benefit without advanced imaging.
176Worst headache of my life + neck stiffness
ANSWERSUBARACHNOID HEMORRHAGE
DANGER'Worst headache of my life' + neck stiffness = subarachnoid hemorrhage — the thunderclap.
TRAPBenign headache doesn't call itself the worst ever with stiff neck.
177SAH + berry aneurysm
ANSWERNimodipine (prevents vasospasm)
SOUNDSAH + berry aneurysm → nimodipine — the vasospasm's shield after the bleed.
TRAPBP-lowering alone doesn't prevent vasospasm; nimodipine does.
178Ptosis + dilated pupil + eye down and out + diabetic
ANSWEROCULOMOTOR NERVE (CN III)
NUMBERPtosis + dilated pupil + down-and-out (diabetic) = CN III — the eye's steering cable snapped.
TRAPCN VI gives inward deviation, no ptosis, no blown pupil.
179Inward eye deviation + diplopia
ANSWERCN VI (abducens)
CLINCHInward eye deviation + diplopia = CN VI — the lateral rectus quit.
TRAPCN III down-and-out would blow the pupil.
180Left-sided ptosis + ophthalmoplegia + right body paralysis
ANSWERBRAINSTEM lesion (alternating syndrome)
PICTURELeft ptosis/ophthalmoplegia + RIGHT body paralysis = brainstem alternating syndrome — same side nerve, opposite side body.
TRAPSupratentorial lesions don't cross signs like this.
181Loss of pain/temp right face + left body
ANSWERLateral medullary (PICA) syndrome → Posterior inferior cerebellar artery
STORYLoss pain/temp RIGHT face + LEFT body = lateral medullary (PICA) — Wallenberg's crossed pattern.
TRAPMedial medullary gives motor crossed, not this exact dissociated sensory pattern.
182Difficulty tying shoelaces/buttoning
ANSWERCORTICOSPINAL TRACT lesion
CLINCHCan't tie shoelaces/button = corticospinal tract — the fine-motor highway's damage.
TRAPCerebellum causes unsteadiness, not specific fine-motor fumbling.
183Weakness left limbs + hyperreflexia + upgoing toe
ANSWERCORTICOSPINAL TRACT lesion
CLINCHLeft weakness + hyperreflexia + upgoing toe = corticospinal tract — the UMN signature.
TRAPLMN gives hyporeflexia and down-going toes.
184Parkinsonism + masked face + pill-rolling tremor + cogwheel rigidity + shuffling gait
ANSWERPARKINSON DISEASE → Dopamine deficiency
PICTUREMasked face + pill-rolling + cogwheel + shuffling = Parkinson disease — dopamine deficiency.
TRAPEssential tremor has no mask, no cogwheel, no shuffle.
185Tremor + rigidity + postural instability + shuffling gait + pill-rolling
ANSWERParkinson disease → DOPAMINE deficiency
CHAINTremor + rigidity + postural instability + shuffling = Parkinson again — dopamine deficit is the answer.
TRAPDrug-induced parkinsonism shares signs but the question asks the disease story.
186Unsteadiness + balance/coordination issues
ANSWERCEREBELLUM lesion
CLINCHUnsteadiness + balance/coordination issues = cerebellum — the body's gyroscope lesion.
TRAPBasal ganglia gives movement quality changes, not pure ataxia.
187Confusion + ataxia + ophthalmoplegia + alcoholic
ANSWERWERNICKE ENCEPHALOPATHY → Thiamine (B1)
DANGERConfusion + ataxia + ophthalmoplegia in alcoholic = Wernicke → thiamine (B1) — the vitamin rescue, urgent.
TRAPHepatic encephalopathy has asterixis, not ophthalmoplegia.
188Chronic alcoholic + confusion/ataxia/ophthalmoplegia
ANSWERThiamine deficiency (B1 — pyruvate dehydrogenase cofactor)
CHAINChronic alcoholic same triad → thiamine — PDH's cofactor, the brain's fuel clerk.
TRAPB12 wouldn't give the acute Wernicke triad.
189Lucid interval + then deterioration + biconvex lens-shaped hematoma
ANSWEREXTRADURAL HEMORRHAGE → Middle meningeal artery
NUMBERLucid interval then deterioration + biconvex hematoma = extradural — the middle meningeal artery's leak.
TRAPSubdural is crescent-shaped and slow; this is biconvex and sneaky-lucid.
190Head injury + lucid interval + biconvex hematoma
ANSWERMiddle meningeal artery rupture
CLINCHHead injury + lucid interval + biconvex = middle meningeal artery rupture — the epidural's source.
TRAPVenous (subdural) bleeds don't give the lucid interval classic.
191Fall 4 weeks ago + progressive decline in consciousness
ANSWERCHRONIC SUBDURAL HEMATOMA
NUMBERFall 4 weeks ago + progressive decline = chronic subdural — the slow venous collection in the elderly.
TRAPExtradural comes hours after the injury, not weeks.
192Migraine prophylaxis
ANSWERSODIUM VALPROATE (or propranolol, amitriptyline)
CLINCHMigraine prophylaxis = sodium valproate (or propranolol, amitriptyline) — the daily shield.
TRAPSumatriptan aborts an attack; it does not prevent.
193C6 spinal lesion
ANSWERDiminished/absent biceps and brachioradialis reflexes
NUMBERC6 lesion → diminished biceps + brachioradialis — the two-reflex level.
TRAPC7 hits the triceps reflex instead.
194C5-C6 injury + waiter's tip + loss sensation lateral forearm
ANSWERUpper trunk brachial plexus
PICTUREC5-C6 + waiter's tip + lateral forearm numbness = upper trunk brachial plexus — Erb's waiter.
TRAPKlumpke (C8-T1) claws the hand, doesn't tip the waiter.
195Foot drop after prolonged squatting + cannot dorsiflex/evert but inversion OK
ANSWERCOMMON PERONEAL NERVE
CLINCHFoot drop after squatting + can't dorsiflex/evert, inversion OK = common peroneal — the fibular head's nerve.
TRAPTibial palsy loses plantar flexion, not dorsiflexion.
196Axillary nerve injury
ANSWERCannot abduct arm >15° but initiation intact + loss sensation regimental badge
NUMBERAxillary nerve: can't abduct >15° but initiation intact + regimental badge numb — the deltoid's nerve.
TRAPSuprascapular handles the first 15°; axillary takes over above.
197Positive feedback example
ANSWEROPENING OF SODIUM CHANNELS during action potential
PICTUREPositive feedback = opening of sodium channels during the action potential — the snowball that fires.
TRAPInsulin-glucose is negative feedback — the opposite loop.
198Pain inhibition by tactile stimulation
ANSWERBETA-TYPE A fibers (mechanoreceptors)
SOUNDPain inhibited by tactile stimulation = beta-type A fibers — the gate's touch keys.
TRAPC fibers carry pain itself; A-beta closes the gate on it.
199Normal saline rapid infusion + normal kidneys
ANSWERIncreased ECF, unchanged ICF, unchanged Na+
CHAINNormal saline rapid infusion + normal kidneys → increased ECF, unchanged ICF, Na+ unchanged — salt stays outside cells.
TRAPD5W would dilute Na+ and swell cells; saline doesn't cross.
200Status epilepticus
ANSWERIV diazepam/lorazepam (first-line)
DANGERStatus epilepticus → IV diazepam/lorazepam first-line — the need-to-stop-now drug.
TRAPPhenytoin loads next; benzos stop the seizure first.
201Absence seizures + staring for seconds + child
ANSWERETHOSUXIMIDE (first-line)
CLINCHAbsence seizures + staring seconds in child → ethosuximide — the stare-stopper of choice.
TRAPCarbamazepine can WORSEN absence.
202Absence seizures (staring)
ANSWEREthosuximide
CHAINAbsence (staring) → ethosuximide — same drug, same stare.
TRAPValproate works too but ethosuximide is the classic first-line answer.
203GCS: eye to pain (2) + incomprehensible sounds (2) + withdraws to pain (4)
ANSWER8
NUMBERGCS: eyes 2 + sounds 2 + withdraws 4 = 8 — and 8 is the intubation threshold.
TRAPMis-summing the three numbers is the classic error; it's 8, not 9.
204OCD first-line
ANSWERSSRIs
ACRONYMOCD first-line = SSRIs — the obsession loop's chemical brake.
TRAPBenzos quiet anxiety but don't treat the OCD loop.
205Schizophrenia + delusions + hallucinations + social withdrawal 1 year
ANSWERSchizophrenia
CLINCHDelusions + hallucinations + social withdrawal 1 year = schizophrenia — the chronic break from reality.
TRAPMood disorder psychosis is mood-congruent and episodic.
206ADHD + always on the go + can't concentrate + interrupts
ANSWERADHD
ACRONYMAlways on the go + can't concentrate + interrupts = ADHD — the motor that never idles.
TRAPAnxiety isn't hyperactive-inattentive across settings.
207GAD + excessive worrying + palpitations + muscle tension + insomnia 8 months
ANSWERGeneralized anxiety disorder
ACRONYMExcessive worry + palpitations + tension + insomnia 8 months = GAD — the worry's marathon.
TRAPPanic disorder is episodic terror, not chronic worry.
208Major depressive disorder + low mood + loss of interest + sleep disturbance 2 months
ANSWERMDD
NUMBERLow mood + loss of interest + sleep disturbance 2 months = MDD — the depressive episode's duration.
TRAPAdjustment disorder is under 2 months with a stressor story.
209OCD + hand washing + knows excessive but can't control
ANSWEROCD
CLINCHHand washing + knows it's excessive but can't control = OCD — ego-dystonic, the fight against oneself.
TRAPPsychotic compulsions lack insight; OCD has the insight and the suffering.
210Delusions + voices + family history
ANSWERSchizophrenia
CLINCHDelusions + voices + family history = schizophrenia — the genetic loading tips it.
TRAPBrief psychotic disorder is shorter and less entrenched.
RHEUMATOLOGY
13 items·2 pods
216Symmetrical joint pain + morning stiffness >1 hour + swollen MCP
ANSWERRHEUMATOID ARTHRITIS
NUMBERSymmetric joint pain + morning stiffness >1h + swollen MCP = RA — the morning grip of inflammation.
TRAPOA stiffens <30 min and spares symmetric MCP swelling.
217RA + rheumatoid factor + anti-CCP
ANSWERDMARDs (methotrexate first-line)
ACRONYMRA + RF + anti-CCP → DMARDs, methotrexate first — the disease-modifying anchor.
TRAPNSAIDs mask symptoms; MTX changes the disease.
218Heberden nodes at DIP
ANSWEROSTEOARTHRITIS
CLINCHHeberden nodes at DIP = osteoarthritis — the wear-and-tear knuckles.
TRAPRA hits MCP/PIP symmetrically, not DIP Heberden.
219Butterfly rash + joint pain
ANSWERSLE → Anti-dsDNA most specific
ACRONYMButterfly rash + joint pain = SLE → anti-dsDNA most specific — the lupus fingerprint.
TRAPANA is sensitive but not specific; anti-dsDNA is.
220Discoid rash + photosensitivity + oral ulcers + joint pain
ANSWERSLE
CLINCHDiscoid rash + photosensitivity + oral ulcers + joint pain = SLE — the skin tells the story.
TRAPDiscoid alone without systemic signs isn't full SLE.
221SLE antibody most specific
ANSWERANTI-dsDNA
CHAINMost specific SLE antibody = anti-dsDNA — the double-strand truth.
TRAPAnti-Smith ties too, but anti-dsDNA is the most specific classic.
222SLE
ANSWERTYPE III HYPERSENSITIVITY (immune complex-mediated)
NUMBERSLE = Type III hypersensitivity — immune complexes driven.
TRAPType II is direct cell attack; SLE is complex-mediated.
223Back pain + morning stiffness + iritis + better with activity + family history
ANSWERANKYLOSING SPONDYLITIS
CLINCHBack pain + morning stiffness + iritis + better with activity + family hx = ankylosing spondylitis — the spine inflames, movement helps.
TRAPMechanical back pain worsens with activity.
224Back pain + morning stiffness + iritis + improves with activity
ANSWERAnkylosing spondylitis
CHAINBack pain + morning stiffness + iritis + better with activity = ankylosing spondylitis — inflammatory back pain's signature.
TRAPOA back pain is worse with movement and rest helps.
225Gout long-term
ANSWERAllopurinol (xanthine oxidase inhibitor)
CHAINGout long-term → allopurinol — the urate factory's brake (xanthine oxidase inhibitor).
TRAPColchicine treats the acute attack, not the long-term crystal load.
226Migratory polyarthritis + pancarditis + post-strep
ANSWERRHEUMATIC FEVER → Mitral valve most commonly affected
STORYMigratory polyarthritis + pancarditis + post-strep = rheumatic fever — mitral valve most affected — the strep's autoimmune echo.
TRAPMigratory + heart = rheumatic; septic joints don't pancarditis.
227Recurrent oral ulcers + genital sores + blurring vision + erythema nodosum
ANSWERBEHCET DISEASE
STORYRecurrent oral ulcers + genital sores + blurring vision + erythema nodosum = Behcet — the vessel inflammation's triad-plus.
TRAPCrohn can bring oral ulcers but not the genital-eye triad.
228Scaly plaques + silvery scales + extensor surfaces + nail pitting
ANSWERPSORIASIS
PICTUREScaly plaques + silvery scales + extensor surfaces + nail pitting = psoriasis — the silvery extensor patches.
TRAPEczema is flexural and weepy, without silvery scales + pitting.
SURGERY — ACUTE ABDOMEN
18 items·3 pods
234Periumbilical
ANSWERRIF pain + fever + nausea + rebound at McBurney → APPENDICITIS → Appendectomy
PICTUREPeriumbilical pain migrating to RIF + McBurney + fever + rebound = appendicitis → appendectomy — the migrant pain.
TRAPDiverticulitis lives LIF, not RIF.
235RIF pain + McBurney tenderness + fever
ANSWERAppendicitis → Appendectomy
CLINCHRIF pain + McBurney tenderness + fever = appendicitis → appendectomy — the right fossa verdict.
TRAPRenal colic radiates to groin, doesn't settle at McBurney.
236Pain out of proportion to exam + AF + severe abdominal pain
ANSWERMESENTERIC ISCHEMIA
DANGERPain out of proportion to exam + AF = mesenteric ischemia — the abdomen screams while the exam whispers.
TRAPPerforation gives rigidity; this is the disproportionate whisper.
237Acute abdominal pain 4th day post-IHD + soft mildly tender + maroon stool
ANSWERMesenteric ischemia
NUMBERDay-4 post-IHD + soft mildly tender + maroon stool = mesenteric ischemia — the low-flow gut infarct.
TRAPDiverticulitis doesn't follow an MI timeline with maroon stool.
238Rigid abdomen + free air under diaphragm
ANSWERPERFORATED VISCUS → Emergency laparotomy
DANGERRigid abdomen + free air = perforated viscus → emergency laparotomy — the board belly.
TRAPObstruction has distension, not board-rigidity + free air.
239RUQ pain + Murphy sign + after heavy meal + obese
ANSWERACUTE CHOLECYSTITIS
CLINCHRUQ pain + Murphy + heavy meal + obese = acute cholecystitis — the fatty meal's gallstone jam.
TRAPCholangitis adds jaundice + fever (Charcot).
240Charcot triad (fever + RUQ pain + jaundice)
ANSWERACUTE CHOLANGITIS
PICTURECharcot triad (fever + RUQ pain + jaundice) = acute cholangitis — the infected bile duct triad.
TRAPCholecystitis alone lacks jaundice.
241Reynolds pentad (Charcot + hypotension + confusion)
ANSWERACUTE CHOLANGITIS
DANGERReynolds pentad = Charcot + hypotension + confusion — cholangitis's decompensation.
TRAPSimple cholecystitis doesn't hit the pentad.
242LIF pain + fever + altered bowel habits + diverticulitis without perforation
ANSWERIV antibiotics + bowel rest
CHAINLIF pain + fever + altered bowel habits + diverticulitis WITHOUT perforation → IV antibiotics + bowel rest — the medical diverticulitis.
TRAPPerforated diverticulitis needs surgery; this one rests and heals.
243Coffee bean sign on X-ray + distension + constipation
ANSWERSIGMOID VOLVULUS
PICTURECoffee bean sign + distension + constipation = sigmoid volvulus — the twisted bean.
TRAPObstruction from adhesions shows air-fluid levels, not the bean.
244Intestinal obstruction + distension + vomiting + constipation
ANSWERNG tube + IV fluids (initial)
DANGERIntestinal obstruction + distension + vomiting + constipation → NG tube + IV fluids initially — decompress first.
TRAPImmediate laparotomy without decompression misses the initial step.
245Intestinal obstruction most common cause in adults
ANSWERPOSTOPERATIVE ADHESIONS
CLINCHAdult obstruction's most common cause = postoperative adhesions — the scar snare.
TRAPHernias are the second act, not the lead.
246Diverticulitis + RLQ pain (cecal)
ANSWERMimics appendicitis
CLINCHCecal diverticulitis + RLQ pain — mimics appendicitis — the right-sided imposter.
TRAPLeft diverticulitis is the classic; cecal is the mimic.
247Malignancy
ANSWERMost common colon polyp type → Villous adenomatous (highest malignant potential)
CLINCHMost common colon polyp type in malignancy = villous adenomatous (highest malignant potential).
TRAPTubular adenomas are common but low-risk.
248Inguinal hernia vs femoral hernia
ANSWERFemoral = below and lateral to pubic tubercle
SOUNDInguinal vs femoral → femoral = below and lateral to pubic tubercle — the F-emoral is F-ar below.
TRAPInguinal hernias sit above and medial.
249Femoral hernia location
ANSWERBELOW AND LATERAL to pubic tubercle
NUMBERFemoral hernia location = below and lateral to pubic tubercle — the low groin pocket.
TRAPAbove-medial points inguinal.
250Incisional hernia + previous gastrectomy + distension
ANSWERAdhesions likely cause of obstruction
CHAINIncisional hernia + previous gastrectomy + distension → adhesions likely — the scar tissue binds the gut.
TRAPRecurrent hernia alone doesn't explain obstruction like adhesions do.
251Appendectomy
ANSWERArtery ligated = ILEOCOLIC artery
CLINCHAppendectomy → artery ligated = ileocolic artery — the appendix's blood supply line.
TRAPRight colic is the ascending colon's, not the appendix's.
SURGERY — TRAUMA / VASCULAR
19 items·3 pods
257Gunshot abdomen + stable (pulse 100, BP 130/80)
ANSWERFAST (first investigation)
ACRONYMGunshot abdomen + stable → FAST first — find the free fluid fast.
TRAPCT in a stable penetrating trauma can wait; FAST is the first look.
258Bullet injury abdomen + stable
ANSWERFAST
DANGERBullet injury + stable → FAST — the unstable patient skips to laparotomy; the stable one scans fast.
TRAPNegative FAST doesn't clear the abdomen, but it is FIRST.
259Unconscious + noisy breathing + facial trauma
ANSWERATLS: SECURE AIRWAY + C-spine protection
DANGERUnconscious + noisy breathing + facial trauma → ATLS: secure airway + C-spine — airway is king.
TRAPScanning the head before the airway is the ATLS sin.
260GCS 4/15 + labored breathing + poisoning
ANSWERSECURE AIRWAY (first step)
DANGERGCS 4/15 + labored breathing + poisoning → secure airway first — the comatose airway is the emergency.
TRAPToxin identification waits; the airway doesn't.
261Tension pneumothorax + tracheal deviation + absent breath sounds + hyperresonance
ANSWERNeedle decompression → Chest tube
DANGERTension pneumothorax + tracheal deviation + absent sounds + hyperresonance → needle decompression → chest tube — the one-way valve burst.
TRAPDoing nothing while the mediastinum shifts kills; needle first.
262Tension pneumothorax sign
ANSWERTRACHEAL DEVIATION to opposite side
CLINCHTension pneumothorax sign = tracheal deviation to the OPPOSITE side — the trachea points away from the tension.
TRAPSame-side deviation is the distractor.
263Spontaneous pneumothorax + sudden pleuritic pain + hyperresonance + absent breath sounds
ANSWERSpontaneous pneumothorax
CLINCHSpontaneous pneumothorax + sudden pleuritic pain + hyperresonance + absent sounds — the tall thin young lung's pop.
TRAPTension adds tracheal deviation + hypotension; spontaneous alone is the collapse.
264Massive hemothorax
ANSWERThoracotomy
DANGERMassive hemothorax → thoracotomy — the chest's big bleed needs the big opening.
TRAPA chest tube alone fails the massive blood loss; thoracotomy is the answer.
265Thoracostomy tube insertion
ANSWER4th-5th intercostal space
NUMBERThoracostomy tube insertion = 4th-5th intercostal space — the safe triangle's floor.
TRAP2nd ICS is for needle decompression, not the tube.
266Ruptured AAA + elderly + sudden severe abdominal/back pain + pulsatile mass + hypotension
ANSWERRuptured AAA → Emergency repair
DANGERElderly + sudden severe abdo/back pain + pulsatile mass + hypotension = ruptured AAA → emergency repair — the aorta's blowout.
TRAPA stable AAA can be elective; rupture is a race.
267AAA + pulsatile mass + sudden abdominal pain + hypotension
ANSWERRuptured AAA
CLINCHAAA + pulsatile mass + sudden pain + hypotension = ruptured AAA — same aortic alarm.
TRAPRenal colic doesn't give a pulsatile mass + hypotension.
268Arterial embolism + AF + cold pulseless painful limb
ANSWEREmbolectomy
CHAINArterial embolism + AF + cold pulseless painful limb → embolectomy — the clot's roadblock, extracted.
TRAPThrombosis in situ is the differential, but AF + embolic = embolectomy.
269DVT
ANSWERWells score → USG → Anticoagulation
CHAINDVT → Wells score → USG → anticoagulation — the clot workup's highway.
TRAPStarting anticoagulation without the ultrasound verdict is the misstep.
270Needle decompression then chest tube
ANSWERTension pneumothorax treatment
DANGERNeedle decompression THEN chest tube = tension pneumothorax treatment — the sequence is the treatment.
TRAPTube without needle wastes the urgent first move; needle without tube recurs.
271Pneumothorax + hyperresonance + absent breath sounds + young + sudden + pleuritic
ANSWERSpontaneous pneumothorax
CLINCHYoung + sudden + pleuritic + hyperresonance + absent breath sounds = spontaneous pneumothorax — the tall-thin pop.
TRAPTension is the same minus hemodynamic collapse; the question's phrasing keeps it spontaneous.
272Compartment syndrome
ANSWERFasciotomy
DANGERCompartment syndrome → fasciotomy — the pressure chamber's release.
TRAPWaiting for pulses to vanish is too late; fasciotomy now.
273Ludwig angina
ANSWERSUBMANDIBULAR/SUBLINGUAL space
PICTURELudwig angina = submandibular/sublingual space — the floor-of-mouth airway threat.
TRAPPeritonsillar abscess is different space, different anatomy.
274Pericardiocentesis
ANSWERLEFT 5TH intercostal space
NUMBERPericardiocentesis = left 5th intercostal space — the subxiphoid/parasternal window to the sac.
TRAP4th-5th midaxillary is the chest tube, not the pericardium.
275Bullet tissue damage most influenced by
ANSWERVELOCITY
CLINCHBullet tissue damage most influenced by VELOCITY — the energy equation's master variable.
TRAPCaliber matters less than the speed squared.
UROLOGY
16 items·3 pods
281Testicular torsion + sudden severe pain + vomiting + high-riding testis + absent cremasteric
ANSWERSURGERY (6-hour window)
NUMBERTesticular torsion + sudden severe pain + vomiting + high-riding testis + absent cremasteric → SURGERY within 6 hours — the 6-hour testicle window.
TRAPEpididymitis has fever and a PRESENT cremasteric; torsion doesn't wait.
282Testicular torsion
ANSWERAbsent cremasteric reflex + high-riding testis → Emergency exploration
DANGERTorsion → absent cremasteric + high-riding testis → emergency exploration — the twisted cord's rescue.
TRAPManual detorsion is temporary; exploration is definitive.
283Elderly smoker + painless total hematuria + ultrasound bladder mass
ANSWERCYSTOSCOPY + biopsy (bladder cancer)
CHAINElderly smoker + painless total hematuria + bladder mass on US → cystoscopy + biopsy — the scope and the tissue.
TRAPImaging alone doesn't give the histology; scope + biopsy do.
284Painless gross hematuria + elderly smoker
ANSWERBladder cancer → Cystoscopy
DANGERPainless gross hematuria + elderly smoker → bladder cancer → cystoscopy — the red-flag combo.
TRAPUTI gives painful hematuria + dysuria.
285Painless hematuria + elderly + smoker
ANSWERBladder cancer → Cystoscopy
CLINCHPainless hematuria + elderly + smoker → bladder cancer → cystoscopy — the same trio, re-asked.
TRAPRenal cell painless hematuria lacks the smoking-bladder link.
286Bladder cancer most common histology
ANSWERTRANSITIONAL CELL CARCINOMA
ACRONYMBladder cancer most common histology = transitional cell carcinoma — the urothelium's tumor.
TRAPSquamous is the schistosomiasis subtype, not the common one.
287BPH + hesitancy + weak stream + nocturia + enlarged smooth prostate
ANSWERAlpha-1 blocker (tamsulosin) first-line
CHAINBPH + hesitancy + weak stream + nocturia + smooth prostate → alpha-1 blocker (tamsulosin) first-line — the smooth-muscle relaxer.
TRAPFinasteride shrinks slowly; tamsulosin opens the faucet fast.
288Prostate cancer + back pain + weight loss + elevated PSA + bone metastasis
ANSWERAndrogen deprivation therapy
DANGERProstate cancer + back pain + weight loss + elevated PSA + bone metastasis → androgen deprivation therapy — starve the prostate's fuel.
TRAPLocal radiation doesn't cover bone mets; ADT is systemic.
289BPH + difficulty starting/weak stream + smooth enlarged prostate
ANSWERAlpha-1 blocker (tamsulosin)
CLINCHBPH + difficulty starting + weak stream + smooth enlarged prostate → alpha-1 blocker — the start-and-stream relief.
TRAPAnticholinergics worsen hesitancy.
290Painful hematuria + dysuria + frequency
ANSWERCystitis/UTI
CLINCHPainful hematuria + dysuria + frequency = cystitis/UTI — the bladder's burning infection.
TRAPPainless hematuria is the cancer red flag; painful is infection.
291Midstream urine
ANSWERMost reliable specimen
CLINCHMidstream urine = most reliable specimen — the mid-catch clean sample.
TRAPFirst-catch samples the urethra.
292Renal stone radiolucent
ANSWERURIC ACID stone
CLINCHRenal stone radiolucent = uric acid — the invisible-on-X-ray stone.
TRAPCalcium stones are radio-opaque.
293Bladder cancer muscle-invasive
ANSWERRadical cystectomy
DANGERBladder cancer muscle-invasive → radical cystectomy — the muscle invasion changes everything.
TRAPTURBT alone is for non-muscle-invasive disease.
294Uncinate process of pancreas
ANSWERSMA passes anteriorly
PICTUREUncinate process of pancreas → SMA passes anteriorly — the retroperitoneal doorway.
TRAPThe uncinate wraps behind the SMA vessels; the SMA is anterior to it.
295Left testicular vein drains into
ANSWERLEFT RENAL VEIN
CHAINLeft testicular vein drains into LEFT RENAL vein — the left side's high detour.
TRAPThe right gonadal vein goes straight to the IVC.
296Radiolucent kidney stone
ANSWERURIC ACID
CLINCHRadiolucent kidney stone = uric acid — the X-ray ghost stone.
TRAPStruvite and calcium are visible; uric acid hides.
BREAST / THYROID
22 items·4 pods
302Painless mobile firm breast lump 2cm upper outer quadrant
ANSWERFIBROADENOMA → Reassurance + follow-up
CLINCHPainless mobile firm lump 2cm UOQ = fibroadenoma → reassure + follow-up — the mobile breast mouse.
TRAPCancer is hard and fixed, not mobile.
303Hard irregular breast lump + peau d'orange
ANSWERBREAST CANCER → FNAC/core biopsy
DANGERHard irregular lump + peau d'orange = breast cancer → FNAC/core biopsy — the orange-peel skin is the alarm.
TRAPFibroadenoma doesn't dimple or peel the skin.
304Breast lump 6x7 cm UOQ + no axillary nodes
ANSWERFIBROADENOMA
NUMBER6x7 cm UOQ lump + NO axillary nodes = fibroadenoma — size and mobility can still be benign when nodes are clean.
TRAPLarge size alone doesn't equal cancer, especially clean axilla.
305Bloody nipple discharge + no lump
ANSWERINTRADUCTAL PAPILLOMA
CLINCHBloody nipple discharge + NO lump = intraductal papilloma — the duct's polyp bleeds.
TRAPCancer usually has a lump; papilloma bleeds alone.
306Breast cancer prognosis most important factor
ANSWERAXILLARY LYMPH NODE STATUS
CLINCHBreast cancer prognosis's most important factor = axillary lymph node status — the armpit decides the future.
TRAPTumor size matters, but nodal status is the top prognostic factor.
307Lactating + painful breast + fever + fluctuation
ANSWERBREAST ABSCESS → Incision and drainage + antibiotics
DANGERLactating + painful breast + fever + fluctuation = breast abscess → incision and drainage + antibiotics — the lactating pus pocket.
TRAPMastitis without fluctuation is antibiotics alone; fluctuation = drain.
308Mondor disease
ANSWERTHROMBOPHLEBITIS of superficial veins of breast
STORYMondor disease = thrombophlebitis of superficial veins of the breast — the breast's tender cord.
TRAPBreast cancer has a mass, not a superficial cord vein.
309Carbuncle neck + diabetic + uncontrolled
ANSWERINCISION AND DRAINAGE
DANGERCarbuncle neck + diabetic + uncontrolled → incision and drainage — the diabetic's carbuncle needs the knife.
TRAPAntibiotics alone leave the carbuncle's core.
310Keloid + scar beyond wound boundary + after excision
ANSWERKeloid
CLINCHKeloid + scar beyond wound boundary = the overgrown scar — excision risks recurrence.
TRAPHypertrophic scar stays within the wound borders.
311Marjolin ulcer + burn scar
ANSWERWide excision
DANGERMarjolin ulcer + burn scar → wide excision — the burn scar's squamous degeneration.
TRAPSimple skin graft ignores the malignancy's field.
312Thyroid nodule solitary + FNAC papillary
ANSWERTotal thyroidectomy
DANGERSolitary thyroid nodule + FNAC papillary → total thyroidectomy — the papillary verdict is the total answer.
TRAPLobectomy under-treats confirmed papillary carcinoma.
313Thyroid surgery + singer
ANSWERRisk: hoarseness (recurrent laryngeal nerve)
PICTUREThyroid surgery + singer → hoarseness risk — recurrent laryngeal nerve, the voice's lifeline.
TRAPHypocalcemia (Chvostek) is the parathyroid story, not the voice.
314Post-thyroidectomy + perioral numbness + Chvostek
ANSWERHYPOCALCEMIA
CHAINPost-thyroidectomy + perioral numbness + Chvostek = hypocalcemia — the parathyroid's removal side effect.
TRAPHoarseness would be the nerve's story; Chvostek is calcium.
315Thyroglossal cyst
ANSWERMidline neck swelling that moves with tongue protrusion
PICTUREThyroglossal cyst = midline neck swelling that MOVES WITH TONGUE PROTRUSION — the tract's tug.
TRAPLymph nodes don't move with the tongue.
316Squamous cell carcinoma lung + hypercalcemia
ANSWERCentral lung mass
CLINCHSquamous cell lung cancer + hypercalcemia = central lung mass — the central squamous sits with calcium.
TRAPAdenocarcinoma is peripheral; squamous is central.
317Squamous cell lung cancer + central mass + hypercalcemia
ANSWERParaneoplastic PTHrP
ACRONYMSquamous cell lung + central mass + hypercalcemia → paraneoplastic PTHrP — the tumor's calcium impersonator.
TRAPBone mets would be the other cause, but the paraneoplastic one is the ask.
318Lung cancer + smoker + hypercalcemia
ANSWERSQUAMOUS CELL carcinoma
CLINCHLung cancer + smoker + hypercalcemia = squamous cell carcinoma — the smoker's squamous calcium dance.
TRAPSmall cell likes hyponatremia, not hypercalcemia.
319Pleural rub
ANSWERScratching sound during respiration
SOUNDPleural rub = scratching sound during respiration — the inflamed pleura's squeak.
TRAPWheezes are musical; the rub is a scratch.
320Gold standard for PE
ANSWERCT pulmonary angiography (CTPA)
ACRONYMGold standard for PE = CT pulmonary angiography (CTPA) — the clot's angiogram.
TRAPV/Q scan is the alternative, not the gold standard.
321Bronchiectasis gold standard
ANSWERHRCT chest
ACRONYMBronchiectasis gold standard = HRCT chest — the dilated bronchi's high-res portrait.
TRAPChest X-ray sees tram-tracks but HRCT confirms.
322COPD + FEV1/FVC reduced
ANSWERCOPD
CLINCHCOPD + FEV1/FVC reduced = COPD — the obstructive ratio's verdict.
TRAPRestrictive disease keeps the ratio; obstruction reduces it.
323ARDS + sepsis + severe hypoxemia
ANSWERLow tidal volume mechanical ventilation (improves survival)
DANGERARDS + sepsis + severe hypoxemia → low tidal volume ventilation — the lung-protective breath that saves.
TRAPHigh tidal volumes re-injure the stiff lung — the ARDS sin.
OBSTETRICS
18 items·3 pods
329BP 160/110 + proteinuria + edema at 32 weeks
ANSWERPREECLAMPSIA
NUMBERBP 160/110 + proteinuria + edema at 32 weeks = preeclampsia — after 20 weeks, pressure + protein = preeclampsia.
TRAPEssential HTN predates pregnancy and lacks the proteinuria signature.
330Preeclampsia + seizure at 38 weeks
ANSWERMAGNESIUM SULFATE (treatment of choice)
ACRONYMPreeclampsia + seizure at 38 weeks = eclampsia → magnesium sulfate — the seizure-stopper of choice.
TRAPDiazepam is general status' drug; magnesium is obstetrics' own.
331Severe abdominal pain + vaginal bleeding + tender rigid uterus + fetal distress at 36 weeks
ANSWERABRUPTIO PLACENTAE
CLINCHSevere abdominal pain + vaginal bleeding + rigid tender uterus + fetal distress = abruptio — the placenta tears away painfully.
TRAPPrevia bleeds painlessly; abruptio is the painful one.
332Painless vaginal bleeding at 30 weeks + placenta covering os
ANSWERPLACENTA PREVIA
CLINCHPainless vaginal bleeding + placenta covering os = placenta previa — the painless low placenta.
TRAPAbruptio is painful; previa is silent until it bleeds.
333Abruptio placentae most important risk factor
ANSWERHYPERTENSION
CLINCHAbruptio's most important risk factor = hypertension — the pressure pops the placenta.
TRAPTrauma is a factor; HTN is the most important.
334Rh-negative mother + Rh-positive baby + jaundice within 24 hours
ANSWERHemolytic disease of newborn → Anti-D within 72 hours
NUMBERRh-neg mother + Rh-pos baby + jaundice within 24 hours = hemolytic disease of newborn → anti-D within 72 hours — the Rh war's ceasefire.
TRAPABO disease is milder and rarely day-one severe.
335Anti-D given to Rh-negative primigravida
ANSWERWithin 72 hours of delivery
NUMBERAnti-D to Rh-negative primigravida = within 72 hours of delivery — the antibody clock.
TRAPAfter 72 hours the sensitization window closes.
336Pregnant + HBIG given
ANSWERThen HBV vaccine within 12-24 hours
NUMBERPregnant + HBIG given → HBV vaccine within 12-24 hours — the passive-active double shot.
TRAPDelaying the vaccine beyond the day risks the vertical escape.
337Glucosuria + family history DM at 22 weeks
ANSWEROGTT (gold standard)
ACRONYMGlucosuria + family history DM at 22 weeks → OGTT — the pregnancy glucose gold standard.
TRAPRandom sugar is a screen; OGTT is the diagnostic gold.
338Pregnancy weight gain for normal BMI
ANSWER11-16 kg
NUMBERPregnancy weight gain for normal BMI = 11-16 kg — the singleton's healthy range.
TRAPOverweight range is lower; 11-16 is the normal-BMI lane.
339Pregnancy anomaly scan timing
ANSWER18-22 weeks
NUMBERPregnancy anomaly scan timing = 18-22 weeks — the anatomy window.
TRAP12 weeks is the nuchal window; the anomaly scan is mid-trimester.
340Hyperthyroid in pregnancy safest
ANSWERPTU (propylthiouracil)
ACRONYMHyperthyroid in pregnancy safest = PTU — the trimester-safe thiourea.
TRAPMethimazole's embryopathy risk makes PTU the pregnancy pick.
341Pregnancy + HTN + BP 150/90 at 8th month
ANSWERLabetalol (category A safe)
CLINCHPregnancy + HTN + BP 150/90 at 8th month → labetalol — the pregnancy-safe alpha-beta blocker.
TRAPACE inhibitors are teratogenic — the absolute no in pregnancy.
342Fertilization site
ANSWERAMPULLA of fallopian tube
PICTUREFertilization site = ampulla of fallopian tube — the wide room where sperm meets egg.
TRAPThe isthmus is too narrow; the ampulla is the meeting room.
343Morning after pill most common
ANSWERLEVONORGESTREL
SOUNDMorning after pill most common = levonorgestrel — the emergency progesterone.
TRAPMifepristone is the abortion pill, not the morning-after.
344HELLP syndrome
ANSWERHemolysis + Elevated Liver enzymes + Low Platelets
ACRONYMHELLP = Hemolysis + Elevated Liver enzymes + Low Platelets — the syndrome spells itself.
TRAPTTP is the mimic but lacks the liver-enzyme elevation pattern.
345Postpartum hemorrhage
ANSWER4 T's: Tone, Trauma, Tissue, Thrombin
NUMBERPostpartum hemorrhage = 4 T's: Tone, Trauma, Tissue, Thrombin — the hemorrhage hunt in order.
TRAPAtony alone is the commonest cause, but the 4-T sweep is the full answer.
346Ectopic pregnancy most common site
ANSWERAMPULLA (fallopian tube)
CLINCHEctopic pregnancy most common site = ampulla — the same wide room, but the pregnancy got lost there.
TRAPCornual ectopics are rare; the ampulla is the classic.
GYNECOLOGY
13 items·2 pods
352Primary amenorrhea + webbed neck + low hairline + streak ovaries + short stature
ANSWERTURNER SYNDROME (45X0)
PICTUREPrimary amenorrhea + webbed neck + streak ovaries + short stature = Turner (45X0) — the XO streak syndrome.
TRAPKallmann spares the ovaries; Turner streaks them.
353Heavy prolonged menstrual bleeding since menarche + negative pregnancy test + normal coagulation
ANSWERANOVULATORY CYCLES
CHAINHeavy prolonged bleeding from menarche + negative pregnancy + normal coagulation = anovulatory cycles — the estrogen-only bleed.
TRAPCoagulopathy would show on coagulation tests; anovulation is the answer.
354Infertility + obesity + hirsutism + irregular cycles + ovarian cysts
ANSWERPOLYCYSTIC OVARIAN SYNDROME (PCOS)
ACRONYMInfertility + obesity + hirsutism + irregular cycles + ovarian cysts = PCOS — the anovulation cluster.
TRAPCushing has striae + cortisol excess, not just the cluster.
355Menorrhagia + abdominal swelling + firm irregular enlarged uterus
ANSWERFIBROID UTERUS (leiomyoma)
CLINCHMenorrhagia + abdominal swelling + firm irregular enlarged uterus = fibroid — the benign knuckles.
TRAPAdenomyosis is uniform and painful; fibroids are irregular and firm.
356Menorrhagia + severe dysmenorrhea + dyspareunia + uniformly enlarged uterus
ANSWERADENOMYOSIS
CLINCHMenorrhagia + severe dysmenorrhea + dyspareunia + uniformly enlarged uterus = adenomyosis — the endometrium inside the muscle.
TRAPFibroids are irregular; adenomyosis is uniform and tender.
357Postmenopausal bleeding + thickened endometrial stripe
ANSWEREndometrial biopsy
DANGERPostmenopausal bleeding + thickened stripe → endometrial biopsy — the thickened lining's verdict.
TRAPUltrasound suggests; the biopsy decides.
358Ovarian mass + greasy material + hair/cartilage/adipose/stratified squamous
ANSWERMATURE CYSTIC TERATOMA (dermoid)
STORYOvarian mass + greasy material + hair/cartilage + squamous = mature cystic teratoma (dermoid) — the tooth-and-hair picnic.
TRAPEndometrioma is chocolate fluid, no teeth.
359Vaginal vault support after hysterectomy
ANSWERUTEROSACRAL LIGAMENTS
CLINCHVaginal vault support after hysterectomy = uterosacral ligaments — the vault's hammock.
TRAPRound ligaments are anterior, not the vault's support.
360Vaginal bleeding + positive pregnancy test + no cardiac activity + dark discharge + closed os
ANSWERMISSED ABORTION
CLINCHVaginal bleeding + positive pregnancy + no cardiac activity + dark discharge + closed os = missed abortion — the pregnancy died but the os stayed shut.
TRAPThreatened abortion has cardiac activity still.
361Morning after pill most common component
ANSWERLEVONORGESTREL
SOUNDMorning after pill most common component = levonorgestrel — the repeat emergency progesterone.
TRAPCombined estrogen (Yuzpe) is the alternative, not the most common.
362Nulliparous + menorrhagia + dysmenorrhea + uniformly enlarged uterus
ANSWERAdenomyosis
CLINCHNulliparous + menorrhagia + dysmenorrhea + uniformly enlarged uterus = adenomyosis — the nulliparous uniform pain.
TRAPFibroids don't demand nulliparity with uniform tenderness.
363Female athlete + amenorrhea + strict diet + marathon
ANSWERDECREASED ESTROGEN (cause of anovulation)
CHAINFemale athlete + amenorrhea + strict diet + marathon = decreased estrogen — the energy deficit's cycle stop.
TRAPPCOS is high-androgen; the athlete is low-estrogen.
364Amenorrhea in athlete
ANSWERDecreased estrogen
CHAINAmenorrhea in athlete → decreased estrogen — the hormone quieted by energy debt.
TRAPPremature ovarian failure is the age-inappropriate mimic.
PEDIATRICS — NEONATOLOGY
18 items·3 pods
370Premature 28 weeks + respiratory distress + ground-glass X-ray
ANSWERRDS → SURFACTANT
PICTUREPremature 28 weeks + respiratory distress + ground-glass = RDS → surfactant — the soap for stiff lungs.
TRAPTTN is transient and milder, no ground-glass.
371Preterm baby 1.2kg at 28 weeks + ground-glass
ANSWERSurfactant
CLINCHPreterm 1.2kg at 28 weeks + ground-glass → surfactant — the smaller the baby, the more it needs the soap.
TRAPAntibiotics are for infection; this is deficiency.
372Preterm neonate prevention
ANSWERBetamethasone (given to mother antenatally)
CHAINPreterm neonate RDS prevention = betamethasone to the MOTHER antenatally — ripen the lungs before birth.
TRAPSurfactant after birth treats; betamethasone before prevents.
373Newborn + no meconium 48 hours + abdominal distension + absent ganglion cells
ANSWERHIRSCHSPRUNG DISEASE
STORYNewborn + no meconium 48h + distension + absent ganglion cells = Hirschsprung — the colon's missing nerve brakes.
TRAPMeconium ileus is cystic fibrosis' story.
374Barium enema + narrow distal + dilated proximal
ANSWERHirschsprung disease
PICTUREBarium enema + narrow distal + dilated proximal = Hirschsprung — the funnel of the aganglionic segment.
TRAPVolvulus is a twist, not a funnel.
375Hirschsprung gold standard
ANSWERRECTAL SUCTION BIOPSY
CLINCHHirschsprung gold standard = rectal suction biopsy — the ganglion cells' verdict.
TRAPBarium enema suggests; biopsy confirms.
376Congenital diaphragmatic hernia + scaphoid abdomen + bowel sounds in chest + respiratory distress
ANSWERCDH
PICTURECDH + scaphoid abdomen + bowel sounds in chest + respiratory distress — the gut climbed into the chest.
TRAPDiaphragmatic eventration is the milder look-alike.
377Neonatal jaundice within 24 hours + Rh-negative mother + Rh-positive baby
ANSWERHemolytic disease of newborn
NUMBERJaundice within 24 hours + Rh-neg mother + Rh-pos baby = hemolytic disease of newborn — day-one jaundice is never physiologic.
TRAPPhysiologic jaundice appears day 2-5.
378Neonatal jaundice + hemolysis
ANSWERIncreased unconjugated bilirubin
CLINCHNeonatal jaundice + hemolysis → increased unconjugated bilirubin — the unprocessed pigment.
TRAPConjugated rises with obstruction, not hemolysis.
379Newborn bleeding from umbilical stump + GI tract + no prophylaxis
ANSWERVITAMIN K deficiency
DANGERNewborn bleeding from stump + GI + no prophylaxis = vitamin K deficiency — the K-missed newborn's bleed.
TRAPHemophilia is factor-specific; the universal K story is the answer.
380Neonatal sepsis most common
ANSWERGROUP B STREPTOCOCCUS
ACRONYMNeonatal sepsis most common = group B strep — the birth canal's colonizer.
TRAPE. coli is late-onset; GBS is the early king.
381Purulent conjunctivitis 2 days after birth + gram-negative diplococci
ANSWERNEISSERIA GONORRHOEAE
NUMBERPurulent conjunctivitis 2 days after birth + gram-negative diplococci = Neisseria gonorrhoeae — the day-2 pus.
TRAPChlamydia is later and less purulent.
382Down syndrome + upward slanting eyes + flat facies + hypotonia + single palmar crease
ANSWERDOWN SYNDROME (Trisomy 21)
PICTUREDown syndrome + upward slant + flat facies + hypotonia + single palmar crease — the Trisomy 21 profile.
TRAPEdward's has clenched fists + rocker-bottom feet.
383Breech extraction + hand weakness + clawing + Horner syndrome
ANSWERLOWER TRUNK brachial plexus injury
PICTUREBreech extraction + hand weakness + clawing + Horner = lower trunk brachial plexus (Klumpke) — the C8-T1 claw + droopy eye.
TRAPErb (C5-6) is the waiter's tip, not the claw + Horner.
384G6PD deficiency + oxidant drugs + Heinz bodies
ANSWERG6PD deficiency
CLINCHG6PD + oxidant drugs + Heinz bodies — X-linked, the enzyme hole in boys.
TRAPSickle cells look different; Heinz bodies are G6PD's.
385Congenital uterine prolapse incidence
ANSWER~0.1%
NUMBERCongenital uterine prolapse incidence ~0.1% — the rare congenital is a trivia line.
TRAPAcquired prolapse is a pelvic-floor story; 0.1% is the congenital number.
386Neonatal hyperbilirubinemia + hemolysis
ANSWERIncreased unconjugated bilirubin
CLINCHNeonatal hyperbilirubinemia + hemolysis → increased unconjugated bilirubin — the hemolysis → unconjugated rule repeats.
TRAPConjugated says obstruction, not hemolysis.
387ABO incompatibility + jaundice
ANSWERDirect Coombs positive
CHAINABO incompatibility + jaundice → direct Coombs positive — the antibody-coated baby cells.
TRAPPhysiologic jaundice is Coombs-negative.
PEDIATRICS — GENERAL
44 items·7 pods
393Fever + drooling + stridor + tripod position
ANSWEREPIGLOTTITIS → Secure airway (DO NOT examine throat)
DANGERFever + drooling + stridor + tripod = epiglottitis → secure airway, DO NOT examine the throat — the airway's emergency door.
TRAPCroup barks but doesn't drool or tripod.
394Epiglottitis in unimmunized children
ANSWERHAEMOPHILUS INFLUENZAE type b
ACRONYMEpiglottitis in unimmunized children = Haemophilus influenzae type b — the vaccine's absence reopens the disease.
TRAPViral croup is the stridor alternative, not epiglottitis' organism.
395Barking cough + inspiratory stridor + worse at night + steeple sign
ANSWERCROUP (laryngotracheobronchitis)
SOUNDBarking cough + inspiratory stridor + worse at night + steeple = croup — the seal's night bark.
TRAPEpiglottitis drools + trips; croup barks.
396Croup + barking cough + steeple sign
ANSWERCroup
PICTURECroup + barking + steeple = croup — the X-ray's steeple is the subglottic tower.
TRAPEpiglottitis shows the thumb sign instead.
397Staring gaze for seconds + normal neuro exam
ANSWERABSENCE SEIZURE → Ethosuximide
CLINCHStaring for seconds + normal neuro exam = absence seizure → ethosuximide — the pause button.
TRAPFocal seizures have motor/sensory features, not just a stare.
398Generalized tonic-clonic >5 minutes without regaining consciousness
ANSWERSTATUS EPILEPTICUS → IV diazepam/lorazepam
NUMBERGeneralized tonic-clonic >5 minutes without returning = status epilepticus → IV diazepam/lorazepam — the 5-minute cutoff.
TRAPA single seizure under 5 minutes isn't status.
399Status epilepticus
ANSWERIV diazepam/lorazepam
DANGERStatus epilepticus → IV diazepam/lorazepam — the need-to-stop benzodiazepine bolt.
TRAPPhenytoin is the second line after benzos.
400ADHD + always on the go + can't sit still + impulsive
ANSWERADHD
ACRONYMADHD + always on the go + can't sit still + impulsive = ADHD — the motor that never idles.
TRAPAnxiety is worry, not the hyperactive-impulsive triad.
401Autism + no speech + avoids eye contact + hand flapping
ANSWERAUTISM SPECTRUM DISORDER
CLINCHAutism + no speech + avoids eye contact + hand flapping = ASD — the social-communication disconnection.
TRAPHearing loss still seeks social connection; autism withdraws.
402Measles + Koplik spots + maculopapular rash starting behind ears + fever/cough/coryza
ANSWERMEASLES
PICTUREMeasles + Koplik spots + rash behind ears = measles — the spot within the mouth is the day-before tell.
TRAPRubella starts face-down with lymphadenopathy, no Koplik.
403Measles vaccine
ANSWERGiven at 9 months (EPI schedule)
NUMBERMeasles vaccine = 9 months (EPI schedule) — the EPI's measles month.
TRAPAt birth is BCG/OPV0, not measles.
404EPI at 9 months
ANSWERMeasles vaccine
NUMBEREPI at 9 months → measles vaccine — the month belongs to measles.
TRAPMMR boosters belong to later ages.
405Developmental milestone: draws a circle
ANSWER36 months
NUMBERDraws a circle = 36 months — the shape milestone ladder: circle 3, cross 4.
TRAP2 years is too early for the circle.
406Infant 9 months
ANSWERsits without support, transfers objects, says mama → Next: PINCER GRASP
CHAIN9 months: sits + transfers + says mama → next = pincer grasp — the tweezers arrive.
TRAPWalking is 12 months; pincer is the 9-month 'next'.
407Developmental milestones: sits + transfers + says mama at 9 months
ANSWERNext = pincer grasp
CLINCHMilestones at 9 months → next = pincer grasp — same ladder, same next step.
TRAPCruising/walking is the 12-month lane.
408Number of teeth at 2 years
ANSWER20 (all primary)
NUMBERTeeth at 2 years = 20 (all primary) — the full baby set by year two.
TRAPThe age×6 formula misleads; 20 is the answer.
409Gower sign + calf hypertrophy
ANSWERDUCHENNE MUSCULAR DYSTROPHY (X-linked recessive)
PICTUREGower sign + calf hypertrophy = Duchenne muscular dystrophy — the boy climbs his own legs.
TRAPBecker is milder and later, same gene.
410Muscular dystrophy + Gower sign
ANSWERX-linked recessive (dystrophin gene)
CLINCHMuscular dystrophy + Gower sign → X-linked recessive (dystrophin gene) — the X-carried muscle loss.
TRAPMyotonic is autosomal; Duchenne is X-linked.
411Pyloric stenosis + olive-shaped mass + vomiting 4-month-old
ANSWERPYLORIC STENOSIS → Ramstedt pyloromyotomy
PICTUREPyloric stenosis + olive-shaped mass + projectile vomiting in 4-month-old → Ramstedt pyloromyotomy — the olive and the split.
TRAPGERD doesn't project an olive.
412Kerosene oil ingestion
ANSWERCHEMICAL PNEUMONITIS → Beta-2 nebulization (NO gastric lavage)
DANGERKerosene ingestion → chemical pneumonitis → beta-2 nebulization, NO gastric lavage — breathing it out, never washing it out.
TRAPLavage/emesis with hydrocarbons is the aspiration death trap.
413Kerosene ingestion + respiratory distress
ANSWERBeta-2 nebulization (NO gastric lavage)
DANGERKerosene + respiratory distress → beta-2 nebulization, no lavage — the airway burns, not the stomach.
TRAPInduced vomiting after hydrocarbons is the classic lethal mistake.
414Lead poisoning + pica + constipation + basophilic stippling
ANSWERSerum lead level
CHAINLead poisoning + pica + constipation + basophilic stippling → serum lead level — the pica-to-stipple trail.
TRAPIron studies don't explain basophilic stippling.
415Celiac disease + diarrhea + FTT + late weaning
ANSWERDuodenal biopsy (gold standard)
CHAINCeliac + diarrhea + FTT + late weaning → duodenal biopsy — the gluten gut's gold standard.
TRAPAnti-TTG screens; the biopsy confirms.
416Gluten-sensitive enteropathy + FTT + diarrhea + protuberant abdomen
ANSWERCeliac disease → Duodenal biopsy
CLINCHGluten-sensitive enteropathy + FTT + diarrhea + protuberant abdomen → celiac → duodenal biopsy — the gluten belly's verdict.
TRAPCow-milk allergy is the differential, not this trigger's diagnosis.
417Child short + healthy + normal US:LS ratio
ANSWERGROWTH HORMONE DEFICIENCY
CLINCHChild short + healthy + normal US:LS ratio = growth hormone deficiency — the proportion-preserving short.
TRAPHypothyroid short has abnormal proportions and bone age.
418Bronchiolitis + wheeze + no fever/weight loss
ANSWERBRONCHIAL ASTHMA
CLINCHBronchiolitis + wheeze + no fever/weight loss = bronchial asthma — recurrent wheeze without infection = asthma.
TRAPBronchiolitis is first-episode with fever in RSV season.
419Asthma severe + unable to complete sentences + O2 sat 86%
ANSWERInhaled salbutamol + oxygen (first-line)
DANGERSevere asthma + can't complete sentences + SpO2 86% → inhaled salbutamol + oxygen first-line — the reliever and the air.
TRAPIV magnesium comes after SABA fails, not before.
420Acute asthma exacerbation + unable to speak + RR 32
ANSWERInhaled SABA (salbutamol) nebulizer
NUMBERAcute asthma + can't speak + RR 32 → inhaled SABA nebulizer — the inhaler first, always.
TRAPSteroids treat inflammation on a delay; SABA is the immediate breath.
421Asthma not responding to bronchodilators/steroids
ANSWERIV magnesium sulfate
CLINCHAsthma not responding to bronchodilators/steroids → IV magnesium sulfate — the refractory storm's brake.
TRAPAminophylline is the older, less-favored step.
422IMCI dehydration + restless + sunken eyes + slow skin pinch + drinks eagerly
ANSWERSOME DEHYDRATION → Plan B
NUMBERIMCI some dehydration: restless + sunken eyes + slow pinch + drinks eagerly → Plan B — ORS under observation.
TRAPPlan C is for severe; never skip to it, never give it lightly.
423Dehydration classification (IMCI)
ANSWERPlan A (none), Plan B (some), Plan C (severe)
ACRONYMIMCI dehydration classification = Plan A (none), B (some), C (severe) — the alphabet ladder.
TRAPPlan B for severe is the classic misstep.
424Kwashiorkor + edema + moon face + fatty liver + sparse hair
ANSWERKWASHIORKOR
PICTUREKwashiorkor + edema + moon face + fatty liver + sparse hair — the proteinless with a full-belly look.
TRAPMarasmus is the wasted, no-edema starvation.
425Nephrotic syndrome + periorbital puffiness + edema + ascites + protein +++
ANSWERPrednisolone (steroid first-line)
CHAINNephrotic + periorbital puffiness + edema + ascites + protein +++ → prednisolone first-line — the steroid-sensitive sieve.
TRAPDiuretics treat the symptom; steroids treat the disease.
426Minimal change disease
ANSWERSteroids first-line
CLINCHMinimal change disease → steroids first-line — minimal change, maximal response.
TRAPCyclophosphamide is the steroid-resistant step.
427Rickets + bowed legs + delayed dentition + widened wrists
ANSWERVITAMIN D deficiency
CLINCHRickets + bowed legs + delayed dentition + widened wrists = vitamin D deficiency — the D-bent bones.
TRAPHypophosphatasia is rare; D deficiency is the everyday answer.
428Short stature + healthy + normal US:LS ratio
ANSWERGrowth hormone deficiency
CLINCHShort stature + healthy + normal US:LS = growth hormone deficiency — the symmetric short.
TRAPConstitutional delay still has a story on bone age.
429Tooth count at 2 years
ANSWER20 teeth
NUMBERTooth count at 2 years = 20 teeth — the full primary set.
TRAPThe age×6 formula misleads; 20 is the hard answer.
430Cystic fibrosis + recurrent respiratory infections + pancreatic insufficiency + elevated sweat chloride
ANSWERCYSTIC FIBROSIS (CFTR mutation)
PICTURECF + recurrent infections + pancreatic insufficiency + elevated sweat chloride = cystic fibrosis — the salty skin print.
TRAPPrimary ciliary dyskinesia has dextrocardia and no pancreatic failure.
431Pompe disease + acid maltase deficiency + glycogen in lysosomes
ANSWERPOMPE DISEASE
CLINCHPompe disease + acid maltase deficiency + glycogen in lysosomes — the lysosomal glycogen storage.
TRAPvon Gierke stores in cytoplasm, not lysosomes.
432Sore throat 2 weeks ago + edema + dark scanty urine + BP elevated
ANSWERPSGN
NUMBERSore throat 2 weeks ago + edema + dark scanty urine + BP up = PSGN — the 2-week echo again.
TRAPIgA hits within days, not weeks.
433Scabies + nocturnal itching + finger webs + family affected
ANSWERPermethrin cream (treatment of choice)
CLINCHScabies + nocturnal itching + finger webs + family affected → permethrin cream — the mite's night itch, the cream for all.
TRAPAntihistamines calm the itch; permethrin kills the mite.
434Diphtheria + gray pseudomembrane
ANSWERDiphtheria antitoxin + antibiotics
DANGERDiphtheria + gray pseudomembrane → antitoxin + antibiotics — the membrane's double treatment.
TRAPAntibiotics alone leave the toxin to kill the heart.
435Hydrocephalus + enlarged head + sunset sign
ANSWERCSF accumulation
PICTUREHydrocephalus + enlarged head + sunset sign = CSF accumulation — the pressure's fluid.
TRAPFamilial macrocephaly has no sunset sign or pressure.
436Strawberry tongue + sandpaper rash + fever
ANSWERSCARLET FEVER (Group A Strep)
CLINCHStrawberry tongue + sandpaper rash + fever = scarlet fever (Group A strep) — the strawberry-sandpaper pair.
TRAPKawasaki has strawberry tongue but no sandpaper rash.
OPHTHALMOLOGY
13 items·2 pods
442Sudden painful vision loss + headache + halos + mid-dilated fixed pupil + ↑IOP
ANSWERACUTE ANGLE-CLOSURE GLAUCOMA
DANGERSudden painful vision loss + halos + mid-dilated fixed pupil + ↑IOP = acute angle-closure glaucoma — the eye's pressure emergency.
TRAPAnterior uveitis is painful but the pupil is small, not fixed-mid-dilated.
443Sudden severe eye pain + redness + halos + mid-dilated fixed pupil
ANSWERAcute angle-closure glaucoma
CLINCHSevere eye pain + redness + halos + fixed mid-dilated pupil = acute angle-closure glaucoma — the halos are the pressure's signature.
TRAPConjunctivitis doesn't give halos or a fixed pupil.
444Gradual painless blurring + difficulty night driving + lens opacity
ANSWERCATARACT
CLINCHGradual painless blurring + night driving trouble + lens opacity = cataract — the lens's slow fog.
TRAPGlaucoma is peripheral field loss with a normal lens.
445Gradual painless vision loss + microaneurysms + dot hemorrhages + hard exudates + diabetic
ANSWERDIABETIC RETINOPATHY
CHAINPainless vision loss + microaneurysms + dot hemorrhages + hard exudates in a diabetic = diabetic retinopathy — diabetes painting the retina.
TRAPHypertensive retinopathy shows AV nicking, not microaneurysms first.
446Proliferative diabetic retinopathy + retinal detachment
ANSWERVitrectomy
DANGERProliferative diabetic retinopathy + retinal detachment → vitrectomy — the detaching retina's surgical rescue.
TRAPLaser alone can't reattach a detached retina.
447Curtain falling over eye + resolves 10 minutes
ANSWERAMAUROSIS FUGAX (TIA)
PICTURECurtain falling over eye, resolves in 10 minutes = amaurosis fugax (TIA) — the eye's transient blackout.
TRAPRetinal detachment's curtain persists with flashes.
448Contact lens + severe eye pain + photophobia + fluorescein staining
ANSWERKERATITIS
DANGERContact lens + severe eye pain + photophobia + fluorescein staining = keratitis — the lens-wearing corneal ulcer.
TRAPConjunctivitis doesn't stain or cause severe pain.
449Inward deviation since infancy + reduced vision + normal structures
ANSWERAMBLYOPIA
CLINCHInward deviation since infancy + reduced vision + normal structures = amblyopia — the lazy eye's picture ignored.
TRAPStrabismus is the deviation; amblyopia is the vision loss it causes.
450Keratoconus + difficulty reading
ANSWERMYOPIA (irregular)
CLINCHKeratoconus + difficulty reading = myopia (irregular) — the cone-shaped cornea bends light wrong.
TRAPPresbyopia is age-related with a normal cornea.
451Sudden painful vision loss + headache + nausea + halos + mid-dilated fixed pupil + ↑IOP
ANSWERAcute angle-closure glaucoma
DANGERSame angle-closure medley + nausea → acute angle-closure glaucoma — nausea accompanies the eye emergency.
TRAPMigraine has no fixed pupil or ↑IOP.
452Optic neuritis
ANSWERMS association
ACRONYMOptic neuritis → MS association — the eye's first demyelinating strike.
TRAPPapilledema is bilateral from ICP, not the MS stripe.
453CRAO
ANSWERCherry-red spot + sudden painless vision loss
PICTURECRAO → cherry-red spot + sudden painless vision loss — the retinal artery's infarct.
TRAPCRVO is the blood-and-thunder different picture.
454CRVO
ANSWERBlood and thunder fundus
SOUNDCRVO → blood and thunder fundus — the venous block's hemorrhagic storm.
TRAPCRAO gives one cherry-red spot, not the storm.
ENT
16 items·3 pods
460Fever + drooling + stridor + tripod position
ANSWEREPIGLOTTITIS → Secure airway (NO throat exam)
DANGERFever + drooling + stridor + tripod = epiglottitis → secure airway, NO throat exam — the airway emergency repeats.
TRAPCroup barks; epiglottitis trips and drools.
461Barking cough + stridor + hoarseness + worse at night + steeple sign
ANSWERCROUP
SOUNDBarking cough + stridor + hoarseness + worse at night + steeple = croup — the night bark + steeple.
TRAPEpiglottitis shows the thumb sign, not the steeple.
462Airplane travel + ear pain/fullness + retracted congested TM
ANSWEROTITIC BAROTRAUMA
STORYAirplane travel + ear pain/fullness + retracted congested TM = otitic barotrauma — the descent's squeeze.
TRAPAcute otitis media has fever + infection, not a flight story.
463Foul-smelling discharge from one nostril + can see something
ANSWERNASAL FOREIGN BODY
CLINCHFoul-smelling discharge from ONE nostril + can see something = nasal foreign body — the single-sided stink.
TRAPSinusitis is bilateral and painful, no visible object.
464Bilateral foul-smelling discharge + pain 6 weeks
ANSWERCHRONIC RHINOSINUSITIS
NUMBERBilateral foul-smelling discharge + pain 6 weeks = chronic rhinosinusitis — the six-week sinus infection.
TRAPAllergic rhinitis is clear and itchy, not foul.
465Fever + sore throat + neck stiffness + pharyngeal abscess + lymphadenopathy
ANSWERRETROPHARYNGEAL ABSCESS → Posterior retropharyngeal space
PICTUREFever + sore throat + neck stiffness + pharyngeal abscess + lymphadenopathy = retropharyngeal abscess — the posterior pharyngeal space infection.
TRAPPeritonsillar abscess gives trismus and uvula deviation.
466Acute otitis media + pain + fever + red TM with no light reflex
ANSWERAcute otitis media
CLINCHAcute otitis media + pain + fever + red TM with no light reflex = AOM — the angry red eardrum.
TRAPOtitis externa hurts on tragus pull, not deep TM redness.
467Otitis externa + ear pain on pulling + no fever + inflamed canal + discharge
ANSWEROtitis externa
CLINCHOtitis externa + pain on PULLING + no fever + inflamed canal + discharge = otitis externa — the canal's swimmer's ear.
TRAPAOM is deep pain with fever, no pull tenderness.
468Vertigo + tinnitus + ear fullness
ANSWERMENIERE DISEASE
ACRONYMVertigo + tinnitus + ear fullness = Meniere disease — the inner-ear pressure triad.
TRAPBPPV is positional and brief without tinnitus.
469Labyrinthitis
ANSWERSudden severe vertigo + nystagmus + hearing loss
CLINCHLabyrinthitis → sudden severe vertigo + nystagmus + hearing loss — the inner-ear storm.
TRAPBPPV spares hearing and is position-triggered.
470BPPV
ANSWERDix-Hallpike positive + brief vertigo with position change
STORYBPPV → Dix-Hallpike positive + brief vertigo with position change — the positional spin.
TRAPMeniere lasts 30+ minutes with audiology signs.
471Meniere
ANSWEREpisodic vertigo + tinnitus + hearing loss + fullness >30 minutes
NUMBERMeniere → episodic vertigo + tinnitus + hearing loss + fullness >30 minutes — the long episodes with all four signs.
TRAPBPPV's vertigo resolves in seconds-to-a-minute.
472Hoarseness + smoker + vocal cord growth
ANSWERBiopsy
DANGERHoarseness + smoker + vocal cord growth → biopsy — the smoker's cord growth is cancer until proven.
TRAPVocal nodules are bilateral and non-smoker; one-sided in a smoker = biopsy.
473Epistaxis
ANSWERLittle area (Kiesselbach plexus)
PICTUREEpistaxis → little area (Kiesselbach plexus) — the anterior septum's bleeding crossroads.
TRAPWoodruff plexus is posterior and rarer.
474Stridor + tripod + drooling
ANSWEREpiglottitis
DANGERStridor + tripod + drooling = epiglottitis — the three-word emergency repeats.
TRAPCroup completes its own triad: bark, steeple, night.
475Foul-smelling discharge + unilateral nostril
ANSWERForeign body (nasal)
CLINCHFoul-smelling discharge + unilateral nostril = foreign body (nasal) — the one-sided smell rule.
TRAPSinusitis is bilateral; one side says object.
APPLIED PATHOLOGY
20 items·3 pods
481Autoimmune hemolytic anemia + Coombs positive
ANSWERTYPE II hypersensitivity (antibody-mediated)
NUMBERAutoimmune hemolytic anemia + Coombs + = Type II hypersensitivity — antibody attacks the cell surface.
TRAPType III is complex-mediated, not direct cell attack.
482SLE
ANSWERTYPE III (immune complex-mediated)
NUMBERSLE = Type III (immune complex) — the immune-complex disease.
TRAPType II is hemolytic anemia's lane, not lupus'.
483TB
ANSWERTYPE IV (delayed-type hypersensitivity)
NUMBERTB = Type IV (delayed-type) — the T-cell delayed war with granulomas.
TRAPType III complexes aren't the TB signature.
484Barrett esophagus (squamous
ANSWERcolumnar) → METAPLASIA
CLINCHBarrett esophagus (squamous → columnar) = metaplasia — one adult cell type adapts into another.
TRAPDysplasia is the premalignant next step, not the change's name.
485Irreversible cell injury
ANSWERNuclear pyknosis + membrane damage
PICTUREIrreversible cell injury → nuclear pyknosis + membrane damage — the nucleus's death sentence.
TRAPReversible injury keeps a live nucleus with swelling.
486Acute inflammation + increased vascular permeability
ANSWERHISTAMINE (immediate)
CHAINAcute inflammation + increased vascular permeability = histamine (immediate) — the mast cell's instant leak.
TRAPProstaglandins come later in the cascade.
487Atherosclerosis
ANSWERPathogenesis: endothelial injury → foam cells → fatty streak → plaque
CHAINAtherosclerosis = endothelial injury → foam cells → fatty streak → plaque — the plaque parade.
TRAPThe parade starts with injury, not lipid alone.
488RAS, MYC, BCL-2, RB oncogenes
ANSWERRB = G1 to S phase inhibitor (retinoblastoma gene)
ACRONYMRAS, MYC, BCL-2, RB oncogenes → RB = G1 to S inhibitor — the cell-cycle brake.
TRAPMYC is an accelerator, not the brake.
489Infarction 40 minutes
ANSWERIrreversible injury → Nuclear pyknosis
NUMBERInfarction 40 minutes → irreversible injury → nuclear pyknosis — crossing the 40-minute line.
TRAPBefore 40 minutes it's still reversible.
490Tumor grade vs stage
ANSWERGrade = cellular differentiation, Stage = extent of spread
CLINCHGrade = cellular differentiation; Stage = extent of spread — the microscope vs the body.
TRAPSwapping them is the classic miss.
491Apoptosis
ANSWERProgrammed cell death (caspase-mediated)
CLINCHApoptosis = programmed cell death (caspase-mediated) — the orderly suicide.
TRAPNecrosis is accidental, messy, inflammatory.
492Starvation ketosis
ANSWERHigh anion gap + no acidosis
CHAINStarvation ketosis → high anion gap + no acidosis — ketones raise the gap but the pH holds.
TRAPDKA is ketosis WITH acidosis and glucose.
493Megaloblastic anemia
ANSWERVitamin B12/Folate deficiency
CLINCHMegaloblastic anemia → vitamin B12/folate deficiency — the DNA-makers' absence.
TRAPIron deficiency gives microcytic cells, not megaloblasts.
494Hemolytic disease of newborn
ANSWERRh incompatibility → Increased unconjugated bilirubin
CHAINHemolytic disease of newborn → Rh incompatibility → increased unconjugated bilirubin — the Rh → hemolysis → bilirubin chain.
TRAPConjugated says obstruction, not the Rh war.
495Coagulation
ANSWERaPTT (intrinsic), PT (extrinsic)
CLINCHCoagulation → aPTT intrinsic, PT extrinsic — the intrinsic/extrinsic alphabet.
TRAPSwap the monitors and the heparin/warfarin answers break.
496DIC
ANSWERMicrothrombi + bleeding → Treat underlying cause
DANGERDIC → microthrombi + bleeding → treat underlying cause — treat the cause, not the numbers.
TRAPBlind product replacement while sepsis rages ignores the driver.
497Immature granulocytes 85%
ANSWERAcute leukemia
NUMBERImmature granulocytes 85% = acute leukemia — the marrow's blast takeover.
TRAPLeukemoid reaction keeps maturing cells.
498Auer rods
ANSWERAML
SOUNDAuer rods = AML — the myeloblast's cytoplasmic cigar.
TRAPALL has no Auer rods.
499RB gene
ANSWERG1 to S phase inhibitor
ACRONYMRB gene = G1 to S phase inhibitor — the checkpoint brake.
TRAPp53 is the apoptosis/repair sentinel, a different gate.
500LDL receptor defect
ANSWERFamilial hypercholesterolemia (Type 2)
CLINCHLDL receptor defect = familial hypercholesterolemia (Type 2) — the broken cholesterol door.
TRAPFamilial combined has no receptor story.
APPLIED ANATOMY
19 items·3 pods
506C5-C6 injury
ANSWERWaiter's tip + loss lateral forearm → Upper trunk brachial plexus
PICTUREC5-C6 injury → waiter's tip + lateral forearm loss = upper trunk (Erb) — Erb's waiter.
TRAPKlumpke claws the hand (C8-T1), doesn't tip the waiter.
507Lower trunk injury (breech)
ANSWERHand weakness + clawing + Horner → Lower trunk brachial plexus
PICTURELower trunk (breech) → hand weakness + clawing + Horner = lower trunk (Klumpke) — the breech's claw + droopy eye.
TRAPErb is the waiter's tip, no Horner.
508C6 lesion
ANSWERDiminished biceps and brachioradialis reflexes
NUMBERC6 lesion → diminished biceps + brachioradialis — the two-reflex level repeats.
TRAPC7 is the triceps reflex.
509Axillary nerve
ANSWERRegimental badge sensation + abduction >15° lost
CLINCHAxillary nerve → regimental badge sensation + abduction >15° lost — the badge patch's nerve.
TRAPSuprascapular owns the first 15°.
510Common peroneal nerve
ANSWERFoot drop + cannot dorsiflex/evert but inversion preserved
CLINCHCommon peroneal → foot drop, can't dorsiflex/evert, inversion PRESERVED — the fibular head's drop.
TRAPTibial loss kills plantar flexion, not inversion-sparing drop.
511Radial nerve
ANSWERWrist drop (cannot extend wrist)
PICTURERadial nerve → wrist drop — the wrist extender's loss.
TRAPUlnar gives clawing, not wrist drop.
512Sciatic nerve
ANSWERInjection in inferior gluteal region
STORYSciatic nerve → injection in inferior gluteal region — the classic injection injury.
TRAPSuperior gluteal spares the sciatic's territory.
513CN III
ANSWERPtosis + dilated pupil + down and out
PICTURECN III → ptosis + dilated pupil + down and out — the eye's steering cable broken.
TRAPCN VI gives pure inward deviation with a normal pupil.
514CN VI
ANSWERInward deviation + diplopia
CLINCHCN VI → inward deviation + diplopia — the lateral rectus quit.
TRAPCN III blows the pupil too; VI is clean.
515Trigeminal
ANSWERJaw deviation to affected side + corneal reflex absent
CLINCHTrigeminal → jaw deviation to affected side + corneal reflex absent — the jaw points at the wound.
TRAPFacial nerve is the smile, not the chew.
516Femoral hernia
ANSWERBelow and lateral to pubic tubercle
CLINCHFemoral hernia → below and lateral to pubic tubercle — the low pocket repeats.
TRAPInguinal is above and medial.
517Pericardiocentesis
ANSWERLeft 5th ICS near sternum
NUMBERPericardiocentesis → left 5th ICS near sternum — the pericardial window repeats.
TRAP4th-5th midaxillary is the chest tube.
518Thoracostomy tube
ANSWER4th-5th ICS
NUMBERThoracostomy tube → 4th-5th ICS — the safe triangle repeats.
TRAP2nd ICS is the decompression needle's spot.
519Left testicular/ovarian vein
ANSWERLeft renal vein
CHAINLeft testicular/ovarian vein → left renal vein — the left side's high detour.
TRAPThe right side drops straight to IVC.
520Uncinate process
ANSWERSMA passes anteriorly
PICTUREUncinate process → SMA passes anteriorly — the retroperitoneal doorway repeats.
TRAPSMA posterior is wrong-door thinking.
521Parietal cells
ANSWERIntrinsic factor + HCl
ACRONYMParietal cells → intrinsic factor + HCl — the P-air: acid and IF.
TRAPChief cells make pepsinogen, not acid.
522Meissner/Auerbach failure
ANSWERHirschsprung
CHAINMeissner/Auerbach failure → Hirschsprung — the missing gut plexuses.
TRAPVolvulus is a twist, not absent ganglia.
523Surgical neck humerus + axillary wound + cannot abduct
ANSWERAxillary nerve
CHAINSurgical neck humerus + axillary wound + can't abduct → axillary nerve — the bone and nerve travel together.
TRAPRadial is the spiral groove midshaft story.
524Regimental badge
ANSWERAxillary nerve (C5-C6)
CLINCHRegimental badge → axillary nerve (C5-C6) — the badge patch's nerve repeats.
TRAPMusculocutaneous is the lateral forearm patch.
APPLIED PHYSIOLOGY
13 items·2 pods
530Positive feedback
ANSWEROpening of Na+ channels during action potential
PICTUREPositive feedback → opening of Na+ channels during action potential — the snowball that fires.
TRAPInsulin-glucose is negative feedback's thermostat.
531Pain inhibited by tactile stimulation
ANSWERBeta-type A fibers (mechanoreceptors)
SOUNDPain inhibited by tactile stimulation → beta-type A fibers — the touch gate closes pain's gate.
TRAPC fibers are the pain; A-beta is the closure.
532Normal saline rapid infusion + normal kidneys
ANSWERIncreased ECF, unchanged ICF, unchanged Na+
CHAINNormal saline rapid + normal kidneys → increased ECF, unchanged ICF, unchanged Na+ — salt stays outside cells.
TRAPD5W would dilute Na+ and swell cells.
533Baroreceptors + squatting
ANSWERstanding → Carotid sinus + aortic arch
CLINCHBaroreceptors squatting → standing → carotid sinus + aortic arch — the pressure pair.
TRAPCarotid bodies are chemical, not pressure.
534Chemoreceptors + hypoxia
ANSWERCarotid and aortic bodies
CLINCHChemoreceptors + hypoxia → carotid and aortic bodies — the oxygen alarm pair.
TRAPCarotid sinus is the pressure sensor, not the O2 one.
535Hemoglobin
ANSWEROxygen transport
CLINCHHemoglobin → oxygen transport — the oxygen bus.
TRAPCO2 is a side job, not the primary line.
536Muscle tone lost after denervation
ANSWERMuscle tone
CLINCHMuscle tone lost after denervation → muscle tone — the wire's loss quiets the muscle.
TRAPUMN spasticity is the opposite, supra-tone.
537Rigor mortis
ANSWERATP depletion in muscles
CHAINRigor mortis → ATP depletion in muscles — the cross-bridges lock without ATP.
TRAPCalcium overload is not the rigor mechanism.
538Rigor mortis first
ANSWERFace and jaw (small muscles)
PICTURERigor mortis first → face and jaw (small muscles) — the face leads the stiffening.
TRAPLimbs stiffen last.
539Muscle atrophy + bed rest
ANSWERImmobilization atrophy (disuse)
CLINCHMuscle atrophy + bed rest → immobilization atrophy (disuse) — use it or lose it.
TRAPDenervation atrophy needs a nerve injury.
540Acid maltase deficiency
ANSWERPompe disease (glycogen storage type II)
SOUNDAcid maltase deficiency → Pompe (glycogen storage type II) — the lysosomal glycogen fill.
TRAPMcArdle is muscle phosphorylase and exercise cramps.
541LDL receptor defective
ANSWERFamilial hypercholesterolemia
CLINCHLDL receptor defective → familial hypercholesterolemia — the broken cholesterol door repeats.
TRAPFamilial combined is a different profile.
542Primary function of hemoglobin
ANSWEROxygen transport
CLINCHPrimary function of hemoglobin → oxygen transport — the bus's day job repeats.
TRAPBuffering is a minor act on the same stage.
CLINICAL PHARMACOLOGY
34 items·5 pods
548Warfarin overdose + bleeding
ANSWERVitamin K (antidote)
CHAINWarfarin overdose + bleeding → vitamin K — the antidote that restarts clotting.
TRAPProtamine is heparin's antidote, not warfarin's.
549Heparin monitoring
ANSWERaPTT
ACRONYMHeparin monitoring → aPTT — the intrinsic clock repeats.
TRAPPT/INR is warfarin's monitor.
550Insulin side effect most common
ANSWERHypoglycemia
CLINCHInsulin's most common side effect = hypoglycemia — the drug's job overshot.
TRAPWeight gain is chronic; hypoglycemia is the acute common.
551Metformin mechanism
ANSWERDecreases hepatic glucose production
CLINCHMetformin → decreases hepatic glucose production — the liver's mute button.
TRAPSulfonylureas secrete insulin; metformin cuts production.
552Thiazolidinediones
ANSWERPPAR-gamma agonists (increase insulin sensitivity)
SOUNDThiazolidinediones = PPAR-gamma agonists — the cells' 'listen to insulin' amplifier.
TRAPThey don't secrete; they sensitize.
553ACE inhibitors
ANSWERContraindicated in pregnancy, bilateral renal artery stenosis
DANGERACE inhibitors → contraindicated in pregnancy + bilateral renal artery stenosis — the two no-go doors.
TRAPAsthma is the beta-blocker no-go, not ACE's.
554Beta blockers
ANSWERContraindicated in asthma, heart block
DANGERBeta blockers → contraindicated in asthma + heart block — the airway and conduction no-go.
TRAPPregnancy bans ACE, not beta-blockers.
555Metformin
ANSWERSTOP if eGFR <30
NUMBERMetformin → STOP if eGFR <30 — the kidney floor.
TRAPeGFR 45 is fine; 30 is the line.
556Opioid overdose + pinpoint pupils + low RR
ANSWERNaloxone
DANGEROpioid overdose + pinpoint pupils + low RR → naloxone — the breath and the miotic pupil.
TRAPFlumazenil is the benzo reversal, wrong receptor here.
557Diazepam overdose
ANSWERFlumazenil (antidote)
CHAINDiazepam overdose → flumazenil — the benzo reversal.
TRAPNaloxone won't touch a benzo overdose.
558Phenytoin
ANSWERGingival hyperplasia + hirsutism
PICTUREPhenytoin → gingival hyperplasia + hirsutism — the gums and the hair.
TRAPCarbamazepine brings SIADH and marrow effects, not gum growth.
559Antiprostaglandins (NSAIDs)
ANSWERInhibit CYCLOOXYGENASE (COX)
ACRONYMAntiprostaglandins (NSAIDs) → inhibit cyclooxygenase (COX) — the prostaglandin tap off.
TRAPLipoxygenase is the leukotriene path, a different enzyme.
560Propranolol
ANSWERBeta blocker for hyperthyroid symptoms
CLINCHPropranolol → beta blocker for hyperthyroid symptoms — the racing heart's brake.
TRAPThionamides treat the gland; propranolol calms the body.
561Allopurinol
ANSWERXanthine oxidase inhibitor (gout prophylaxis)
CLINCHAllopurinol → xanthine oxidase inhibitor (gout prophylaxis) — the urate factory's brake.
TRAPColchicine is the acute attack drug, not prophylaxis.
562Aspirin
ANSWERIrreversible COX-1 inhibitor (antiplatelet)
CHAINAspirin → irreversible COX-1 inhibitor (antiplatelet) — the one-way platelet killer.
TRAPIbuprofen is reversible, the shorter effect.
563Atropine
ANSWERFirst-line for symptomatic bradycardia
CLINCHAtropine → first-line for symptomatic bradycardia — the vagal brake released.
TRAPPacing is for the atropine-refractory patient.
564Norepinephrine
ANSWERFirst-line vasopressor in septic shock
CLINCHNorepinephrine → first-line vasopressor in septic shock — the septic squeeze.
TRAPDopamine is the second-line relic.
565MgSO4
ANSWERTreatment of eclampsia/prevention of seizures
ACRONYMMgSO4 → treatment of eclampsia/prevention of seizures — the obstetric seizure stopper.
TRAPDiazepam is general status; magnesium is eclampsia's.
566Nimodipine
ANSWERPrevents cerebral vasospasm after SAH
SOUNDNimodipine → prevents cerebral vasospasm after SAH — the spasm shield.
TRAPBP control alone doesn't prevent the delayed spasm.
567Octreotide
ANSWERReduces portal pressure in variceal bleeding
SOUNDOctreotide → reduces portal pressure in variceal bleeding — the splanchnic squeeze.
TRAPPPI doesn't touch portal pressure.
568SABA (salbutamol)
ANSWERFirst-line for acute asthma exacerbation
ACRONYMSABA (salbutamol) → first-line for acute asthma exacerbation — the immediate reliever.
TRAPSteroids are the delayed controller, not the acute first punch.
569PPI + amoxicillin + clarithromycin
ANSWERH. pylori triple therapy
ACRONYMPPI + amoxicillin + clarithromycin → H. pylori triple therapy — the eradication trio.
TRAPPPI alone heals but the bug survives.
570Vitamin B1 (thiamine)
ANSWERBeriberi, Wernicke encephalopathy
NUMBERVitamin B1 (thiamine) → beriberi, Wernicke encephalopathy — the brain's fuel clerk.
TRAPB12 is the cord and megaloblasts, not Wernicke.
571Vitamin B12
ANSWERMegaloblastic anemia + subacute combined degeneration
NUMBERVitamin B12 → megaloblastic anemia + subacute combined degeneration — blood and cord together.
TRAPFolate spares the cord and masks the blood.
572Vitamin K
ANSWERNewborn prophylaxis against hemorrhagic disease
CHAINVitamin K → newborn prophylaxis against hemorrhagic disease — the K shot.
TRAPVitamin C prevents scurvy, not the newborn bleed.
573Vitamin C
ANSWERScurvy (bleeding gums, poor wound healing, perifollicular hemorrhages)
ACRONYMVitamin C → scurvy (bleeding gums, poor wound healing, perifollicular hemorrhages) — the collagen strand.
TRAPK bleeds from clotting loss; C bleeds from collagen loss.
574Vitamin D
ANSWERRickets (bowed legs, delayed dentition, widened wrists)
ACRONYMVitamin D → rickets (bowed legs, delayed dentition, widened wrists) — the D-bent bones.
TRAPCalcium alone misses the absorption key.
575Fexofenadine
ANSWERLeast sedating antihistamine (taxi driver safe)
STORYFexofenadine → least sedating antihistamine (taxi driver safe) — the wide-awake antihistamine.
TRAPDiphenhydramine is the sedating first-gen nap.
576Haloperidol
ANSWERAntipsychotic causing EPS (rigidity, tremors, bradykinesia)
ACRONYMHaloperidol → antipsychotic causing EPS (rigidity, tremors, bradykinesia) — the motor-cost antipsychotic.
TRAPClozapine's cost is agranulocytosis, not EPS.
577SSRIs
ANSWERFirst-line for OCD
ACRONYMSSRIs → first-line for OCD — the obsession loop's brake.
TRAPBenzos quiet anxiety but don't treat the loop.
578Sodium valproate
ANSWERMigraine prophylaxis
CLINCHSodium valproate → migraine prophylaxis — the daily shield.
TRAPSumatriptan aborts an attack; it doesn't prevent.
579Ethosuximide
ANSWERAbsence seizures
CLINCHEthosuximide → absence seizures — the stare-stopper.
TRAPCarbamazepine can worsen absence.
580Flumazenil
ANSWERBenzodiazepine overdose antidote
SOUNDFlumazenil → benzodiazepine overdose antidote — the benzo reversal repeats.
TRAPNaloxone is opioids only.
581Naloxone
ANSWEROpioid overdose antidote
SOUNDNaloxone → opioid overdose antidote — the breath returns.
TRAPFlumazenil is benzos only.
APPLIED BIOCHEMISTRY
16 items·3 pods
587Ketone body synthesis
ANSWERHMG-CoA SYNTHASE (acetyl-CoA → HMG-CoA)
CLINCHKetone body synthesis → HMG-CoA synthase — the ketone factory's first enzyme.
TRAPHMG-CoA reductase builds cholesterol, the statin target.
588Maple syrup urine disease
ANSWERValine, leucine, isoleucine (branched-chain amino acids)
ACRONYMMaple syrup urine disease → valine, leucine, isoleucine — the VLI branched chains smell maple.
TRAPPKU is phenylalanine, a different amino acid.
589Ammonia metabolism in liver
ANSWERBinds to GLUTAMATE
CLINCHAmmonia metabolism in liver → binds to glutamate — the ammonia taxi.
TRAPUrea cycle is the final road; glutamate is the first hop.
590Pyruvate dehydrogenase cofactor
ANSWERThiamine (B1)
ACRONYMPyruvate dehydrogenase cofactor → thiamine (B1) — PDH needs the B1 key.
TRAPB12 is methionine synthase's cofactor, not PDH's.
591Collagen hydroxylation defect
ANSWERVitamin C deficiency
CHAINCollagen hydroxylation defect → vitamin C deficiency — the hydroxylation needs C.
TRAPVitamin D is bones, not collagen cross-links.
592HMG-CoA
ANSWERKetone body synthesis → HMG-CoA synthase
CLINCHHMG-CoA → ketone body synthesis → HMG-CoA synthase — ketogenesis's door repeats.
TRAPReductase is the cholesterol door.
593LDL receptor defect
ANSWERFamilial hypercholesterolemia
CLINCHLDL receptor defect → familial hypercholesterolemia — the broken cholesterol door repeats.
TRAPFamilial combined has a different mechanism.
594Pompe disease
ANSWERAcid maltase deficiency (glycogen in lysosomes)
SOUNDPompe disease → acid maltase deficiency (glycogen in lysosomes) — the lysosomal fill.
TRAPvon Gierke is cytoplasmic glycogen.
59511-beta-hydroxysteroid dehydrogenase
ANSWERInterconverts mineralocorticoids and glucocorticoids
NUMBER11-beta-hydroxysteroid dehydrogenase → interconverts mineralocorticoids and glucocorticoids — the cortisol-cortisone doorman.
TRAP21-hydroxylase is cortisol synthesis (CAH), a different enzyme.
596Metabolic acidosis with normal anion gap
ANSWERDIARRHEA (loss of HCO3)
CLINCHMetabolic acidosis with normal anion gap → diarrhea (loss of HCO3) — the bicarbonate drain.
TRAPDKA is high-gap from ketones.
597High anion gap metabolic acidosis
ANSWERDKA, methanol, uremia, lactic acidosis
ACRONYMHigh anion gap acidosis → DKA, methanol, uremia, lactic acidosis — MUDPILES.
TRAPDiarrhea is the normal-gap story.
598Metabolic alkalosis
ANSWERVomiting, diuretics
CHAINMetabolic alkalosis → vomiting, diuretics — losing acid or shuffling electrolytes.
TRAPDiarrhea is the opposite: acidosis.
599Respiratory acidosis
ANSWERHypoventilation (COPD, opioid overdose)
CLINCHRespiratory acidosis → hypoventilation (COPD, opioid overdose) — slow breathing hoards CO2.
TRAPHyperventilation blows CO2 off, alkalosis.
600Respiratory alkalosis
ANSWERHyperventilation (anxiety, PE, salicylate early)
CLINCHRespiratory alkalosis → hyperventilation (anxiety, PE, early salicylate) — fast breathing blows off CO2.
TRAPHypoventilation retains CO2, acidosis.
601Acid maltase deficiency
ANSWERPompe disease
SOUNDAcid maltase deficiency → Pompe disease — the lysosomal Pompe repeats.
TRAPMcArdle is phosphorylase and muscle cramps.
602HMG-CoA synthase
ANSWERKey enzyme in ketogenesis
CLINCHHMG-CoA synthase → key enzyme in ketogenesis — the ketone door repeats.
TRAPReductase is cholesterol's door, the classic confusion pair.
COMMUNITY MEDICINE / EPIDEMIOLOGY
16 items·3 pods
608Population growth 2% annually
ANSWERDoubling time ~35 years (Rule of 70: 70/2 = 35)
NUMBERPopulation growth 2% → doubling time ~35 years (Rule of 70: 70/2 = 35) — the rule of 70.
TRAP70/2 = 140 is the divide-vs-divide error; it's 35.
609EPI schedule: measles vaccine
ANSWERAT 9 MONTHS
NUMBEREPI measles vaccine → at 9 months — the measles month repeats.
TRAPAt birth is BCG/OPV0.
610EPI at 9 months
ANSWERMeasles vaccine (first dose)
NUMBEREPI at 9 months → measles vaccine (first dose) — the month's appointment repeats.
TRAPMMR boosters come later.
611Screening for colorectal cancer
ANSWERStart at 45-50 years
NUMBERColorectal screening → start at 45-50 — the saving decade.
TRAP60 is too late for the preventable window.
612Positive FOBT
ANSWERNext step = COLONOSCOPY
CHAINPositive FOBT → next step = colonoscopy — the scope follows the positive.
TRAPRepeating FOBT wastes the signal.
613IMCI: some dehydration (restless, sunken eyes, slow skin pinch, drinks eagerly)
ANSWERPLAN B
NUMBERIMCI some dehydration (restless, sunken eyes, slow pinch, drinks eagerly) → Plan B — ORS under supervision.
TRAPPlan C is the severe-IV lane.
614IMCI: severe dehydration
ANSWERPlan C (IV fluids)
NUMBERIMCI severe dehydration → Plan C (IV fluids) — the IV road.
TRAPPlan B is 'some', not severe.
615Sensitivity/Specificity
ANSWERSnNout, SpPin
ACRONYMSensitivity/Specificity → SnNout, SpPin — the mnemonic's rules.
TRAPSnPin/SpNout reversed is the classic miss.
616Incidence vs Prevalence
ANSWERIncidence = new cases, Prevalence = total cases
CLINCHIncidence vs Prevalence → incidence = new cases, prevalence = total — flow vs stock.
TRAPSwapping the flow and stock is the classic error.
617Study designs
ANSWERRCT (gold standard), Cohort (prognosis), Case-control (rare diseases)
CHAINStudy designs → RCT (gold standard), cohort (prognosis), case-control (rare) — the design menu.
TRAPCross-sectional is a snapshot, not a direction.
618Hepatitis B
ANSWERAnti-HBsAg detectable from vaccination
SOUNDHepatitis B → anti-HBsAg detectable from vaccination — the good antibody.
TRAPAnti-HBc is infection's print, never from the shot.
619Hepatitis B + vertical transmission prevention
ANSWERHBIG + vaccine within 12-24 hours
NUMBERHep B vertical prevention → HBIG + vaccine within 12-24 hours — the newborn's twin shot.
TRAPVaccine alone is too slow against vertical spread.
620Colorectal cancer screening start
ANSWER45-50 years
NUMBERColorectal screening start → 45-50 — the decade repeats.
TRAP40 is earlier than the average-risk guideline.
621Doubling time
ANSWER70/growth rate
NUMBERDoubling time → 70/growth rate — the rule of 70 formula.
TRAP72/rate is the finance cousin; the book answer is 70.
622ACT therapy + malaria
ANSWERReduces resistance
CHAINACT therapy + malaria → reduces resistance — the combination's point.
TRAPMonotherapy artemisinin is what breeds resistance.
623Neoadjuvant therapy
ANSWERGiven BEFORE surgery
CLINCHNeoadjuvant therapy → given BEFORE surgery — 'neo' = new, before.
TRAPAdjuvant is after surgery, the mopping-up.
FORENSIC MEDICINE
20 items·3 pods
629Cherry-red postmortem staining + closed room + smoke
ANSWERCARBON MONOXIDE poisoning
PICTURECherry-red postmortem staining + closed room + smoke = carbon monoxide — the cherry-red poison.
TRAPLividity alone is purple; cherry-red says CO.
630Body in water + white froth + overdistended lungs
ANSWERDROWNING
PICTUREBody in water + white froth + overdistended lungs = drowning — the wet autopsy.
TRAPChoking has a plug, no froth-filled lungs.
631Ligature mark high up + oblique upward to mastoid + saliva dribbling
ANSWERHANGING
CLINCHLigature mark high up + oblique upward to mastoid + saliva dribbling = hanging — the high oblique mark.
TRAPStrangulation's mark is low and horizontal, no dribble.
632Time since death + cold body + fixed lividity + rigor in face/trunk/limbs
ANSWER8-10 hours
NUMBERTime since death + cold body + fixed lividity + rigor in face/trunk/limbs → 8-10 hours — the rigor's spread window.
TRAPFresh-death answer (1-2h) ignores the fixed lividity + full rigor.
633Rigor mortis
ANSWERATP DEPLETION (first in face/jaw)
CHAINRigor mortis → ATP depletion (first in face/jaw) — the energy lock repeats.
TRAPCalcium overload is not the mechanism.
634Rigor mortis first
ANSWERFace and jaw (small muscles)
PICTURERigor mortis first → face and jaw (small muscles) — the face leads repeats.
TRAPLimbs are last.
635Organ putrefaction LAST
ANSWERPROSTATE (uterus in females)
CLINCHOrgan putrefaction LAST → prostate (uterus in females) — the prostate's stubbornness.
TRAPThe gut goes first; the prostate holds out.
636Criminal negligence + surgeon drunk during surgery
ANSWERCRIMINAL NEGLIGENCE
DANGERCriminal negligence + surgeon drunk during surgery → criminal negligence — the surgeon's gross recklessness.
TRAPCivil negligence is a duty failure, not drunken surgery.
637Surgeon under alcohol influence + patient death
ANSWERCriminal negligence
DANGERSurgeon under alcohol + patient death → criminal negligence — the alcohol makes it gross.
TRAPSimple error without intoxication stays civil.
638Postmortem lividity + cherry-red
ANSWERCO poisoning
CLINCHPostmortem lividity + cherry-red → CO poisoning — the cherry-red repeats.
TRAPHypoxia's lividity is purple, not cherry.
639Bullet tissue damage depends on
ANSWERVELOCITY
CLINCHBullet tissue damage depends on → velocity — the energy equation repeats.
TRAPCaliber is secondary to velocity squared.
640Consent for child minor
ANSWERParents give consent
CLINCHConsent for child minor → parents give consent — the proxy giver.
TRAPMature-minor exceptions exist but the rule is parents.
641Consent for surgery on woman
ANSWERValid informed consent before surgery
CLINCHConsent for surgery on woman → valid informed consent before surgery — the rule of informed consent.
TRAPEmergency exceptions aside, consent precedes surgery.
642Organophosphate poisoning
ANSWERAtropine + pralidoxime
CHAINOrganophosphate poisoning → atropine + pralidoxime — the cholinergic double counter.
TRAPNaloxone is opioid, not cholinergic.
643Opioid overdose
ANSWERNaloxone
CLINCHOpioid overdose → naloxone — the opioid reversal repeats.
TRAPFlumazenil is benzos.
644Benzodiazepine overdose
ANSWERFlumazenil
CLINCHBenzodiazepine overdose → flumazenil — the benzo reversal repeats.
TRAPNaloxone is opioids.
645Criminal negligence
ANSWERgross recklessness; Civil negligence → failure of duty of care
CLINCHCriminal negligence = gross recklessness; civil = failure of duty of care — the two-tier negligence.
TRAPConflating the two tiers is the classic miss.
646Postmortem staining + cherry-red
ANSWERCarbon monoxide
CLINCHPostmortem staining + cherry-red → carbon monoxide — the cherry-red staining repeats.
TRAPPurple staining is normal lividity.
647Body found with froth at mouth/nose
ANSWERDrowning
PICTUREBody found with froth at mouth/nose → drowning — the froth repeats.
TRAPCO poisoning gives cherry-red, not froth.
648Hanging vs strangulation
ANSWERHanging: ligature mark high up, oblique, no other marks
CLINCHHanging vs strangulation → hanging: ligature mark high up, oblique, no other marks — the hangman's mark.
TRAPStrangulation: low, horizontal, with struggle marks.
MISCELLANEOUS HIGH-YIELD
44 items·7 pods
654Most common cause CAP
ANSWERSTREP PNEUMONIAE
CLINCHMost common CAP → Strep pneumoniae — the lobar guest repeats.
TRAPAtypicals are the variation.
655Most common UTI organism
ANSWERE. COLI
CLINCHMost common UTI organism → E. coli — the perineal climber repeats.
TRAPEnterococcus is the nitrate-negative exception.
656Most common hyperthyroidism
ANSWERGRAVES DISEASE
CLINCHMost common hyperthyroidism → Graves — the common name repeats.
TRAPToxic nodule is regional.
657Most common neonatal sepsis
ANSWERGROUP B STREP
ACRONYMMost common neonatal sepsis → group B strep — the birth canal's colonizer repeats.
TRAPE. coli is late onset.
658Most common osteomyelitis in sickle cell
ANSWERSALMONELLA
CLINCHMost common osteomyelitis in sickle cell → Salmonella — the sickle unusual suspect repeats.
TRAPStaph is usual; sickle flips it.
659Most common acute hepatitis in children
ANSWERHEPATITIS A
CLINCHMost common acute hepatitis in children → hepatitis A — the fecal-oral kid favorite repeats.
TRAPHep B is the vertical story.
660Most common site of fertilization
ANSWERAMPULLA
CLINCHMost common site of fertilization → ampulla — the meeting room repeats.
TRAPIsthmus is too narrow.
661Most common ectopic site
ANSWERAMPULLA
CLINCHMost common ectopic site → ampulla — the lost-room repeats.
TRAPCornual is rare.
662Most common berry aneurysm site
ANSWERANTERIOR COMMUNICATING
CLINCHMost common berry aneurysm site → anterior communicating — the junction's weak link repeats.
TRAPMCA is common but not the 'most common berry'.
663Most common polyp malignancy
ANSWERVILLOUS ADENOMA
CLINCHMost common polyp malignancy → villous adenoma — the villous troublemaker repeats.
TRAPTubular is common but low-risk.
664Most common bladder CA
ANSWERTRANSITIONAL CELL
CLINCHMost common bladder CA → transitional cell — the urothelium's tumor repeats.
TRAPSquamous is the schistosomiasis subtype.
665Most common cause death in TTP
ANSWERINTRACRANIAL HEMORRHAGE
DANGERMost common cause of death in TTP → intracranial hemorrhage — the low-platelet brain bleed repeats.
TRAPRenal failure is a feature, not the killer.
666Most common intra-abdominal tumor in child
ANSWERWILM TUMOR (or Neuroblastoma)
CLINCHMost common intra-abdominal tumor in child → Wilm tumor (or neuroblastoma) — the kid's abdominal mass.
TRAPAdults' tumors don't apply here.
667Most common side effect insulin
ANSWERHYPOGLYCEMIA
CLINCHMost common side effect insulin → hypoglycemia — the overshoot repeats.
TRAPLipohypertrophy is site-related, not the common side effect.
668Most common cause obstruction in adults
ANSWERPOSTOPERATIVE ADHESIONS
CLINCHMost common cause obstruction in adults → postoperative adhesions — the scar snare repeats.
TRAPHernias are second act.
669Most common cause epiglottitis in unimmunized
ANSWERH. INFLUENZAE type b
ACRONYMMost common cause epiglottitis in unimmunized → H. influenzae type b — the vaccine gap repeats.
TRAPViral croup is the stridor differential, not epiglottitis' organism.
670Best initial test for MI
ANSWERTroponin (most specific)
CLINCHBest initial test for MI → troponin (most specific) — the cardiac report card repeats.
TRAPCK-MB is earlier but less specific.
671Gold standard for PE
ANSWERCTPA
ACRONYMGold standard for PE → CTPA — the clot angiogram repeats.
TRAPV/Q is the alternative, not the gold.
672Gold standard for bronchiectasis
ANSWERHRCT
ACRONYMGold standard for bronchiectasis → HRCT — the high-res portrait repeats.
TRAPCXR sees tram-tracks but HRCT confirms.
673Gold standard for Hirschsprung
ANSWERRectal suction biopsy
CLINCHGold standard for Hirschsprung → rectal suction biopsy — the ganglion verdict repeats.
TRAPBarium enema suggests; biopsy confirms.
674Gold standard for H. pylori eradication
ANSWERUrea breath test
CLINCHGold standard for H. pylori eradication → urea breath test — the non-invasive follow-up repeats.
TRAPEndoscopic biopsy is invasive; breath is the follow-up gold.
675Gold standard for DM in pregnancy
ANSWEROGTT
ACRONYMGold standard for DM in pregnancy → OGTT — the pregnancy glucose gold repeats.
TRAPRandom sugar is a screen.
676First-line BPH
ANSWERAlpha-1 blocker (tamsulosin)
CLINCHFirst-line BPH → alpha-1 blocker (tamsulosin) — the faucet opener repeats.
TRAPFinasteride shrinks slowly.
677First-line HTN in DM with proteinuria
ANSWERACE inhibitor
ACRONYMFirst-line HTN in DM with proteinuria → ACE inhibitor — the renal shield repeats.
TRAPBeta blockers lower BP but not with the renal-protection title.
678First-line sepsis vasopressor
ANSWERNOREPINEPHRINE
CLINCHFirst-line sepsis vasopressor → norepinephrine — the septic squeeze repeats.
TRAPDopamine is the relic.
679First-line asthma exacerbation
ANSWERSABA (salbutamol)
ACRONYMFirst-line asthma exacerbation → SABA (salbutamol) — the immediate reliever repeats.
TRAPSteroids are the delayed controller.
680First-line acute asthma
ANSWERInhaled SABA
CLINCHFirst-line acute asthma → inhaled SABA — the inhaler first repeats.
TRAPIV magnesium is the refractory step.
681First-line OCD
ANSWERSSRIs
ACRONYMFirst-line OCD → SSRIs — the loop's brake repeats.
TRAPBenzos don't treat the loop.
682First-line absence seizures
ANSWEREthosuximide
CLINCHFirst-line absence seizures → ethosuximide — the stare-stopper repeats.
TRAPCarbamazepine worsens absence.
683First-line status epilepticus
ANSWERIV diazepam/lorazepam
DANGERFirst-line status epilepticus → IV diazepam/lorazepam — the benzo bolt repeats.
TRAPPhenytoin is second line.
684First-line symptomatic bradycardia
ANSWERIV atropine
CLINCHFirst-line symptomatic bradycardia → IV atropine — the vagal release repeats.
TRAPPacing is the refractory step.
685First-line hyperkalemia emergency
ANSWERIV calcium gluconate
DANGERFirst-line hyperkalemia emergency → IV calcium gluconate — the myocardial shield repeats.
TRAPInsulin/glucose shifts; calcium stabilizes first.
686First-line C. difficile
ANSWEROral vancomycin
CLINCHFirst-line C. difficile → oral vancomycin — the gut clean-up repeats.
TRAPMetronidazole is the step-down.
687First-line ADHD
ANSWERMethylphenidate (behavioral therapy first)
CLINCHFirst-line ADHD → methylphenidate (behavioral therapy first) — the stimulant with behavior first.
TRAPMedication without behavioral therapy misses the first line.
688First-line preeclampsia seizure
ANSWERMAGNESIUM SULFATE
ACRONYMFirst-line preeclampsia seizure → magnesium sulfate — the obstetric stopper repeats.
TRAPDiazepam is general status.
689First-line Gout prophylaxis
ANSWERAllopurinol
CLINCHFirst-line gout prophylaxis → allopurinol — the urate brake repeats.
TRAPColchicine is acute, not prophylaxis.
690Most sensitive early osteomyelitis
ANSWERMRI
ACRONYMMost sensitive early osteomyelitis → MRI — the marrow's early eye.
TRAPX-ray lags weeks; MRI sees early marrow edema.
691Best view ankle joint
ANSWERMORTISE view
CLINCHBest view ankle joint → mortise view — the ankle's true joint view.
TRAPAP alone overlaps the mortise.
692Most reliable urine specimen
ANSWERMIDSTREAM voiding
CLINCHMost reliable urine specimen → midstream voiding — the mid-catch repeats.
TRAPFirst-catch samples the urethra.
693Most important prognostic factor breast CA
ANSWERAXILLARY LYMPH NODE STATUS
CLINCHMost important prognostic factor breast CA → axillary lymph node status — the armpit decides repeats.
TRAPTumor size matters, nodes decide.
694Most specific antibody SLE
ANSWERANTI-dsDNA
ACRONYMMost specific antibody SLE → anti-dsDNA — the lupus fingerprint repeats.
TRAPANA is sensitive, not specific.
695Most common valve affected in rheumatic
ANSWERMITRAL VALVE
CLINCHMost common valve affected in rheumatic → mitral — the rheumatic valve repeats.
TRAPAortic is second, mitral the most common.
696Most important risk factor abruption
ANSWERHYPERTENSION
CLINCHMost important risk factor abruption → hypertension — the pressure pops repeats.
TRAPTrauma is a factor, HTN is the most important.
697Characteristics of irreversible cell injury
ANSWERNuclear pyknosis + membrane damage
CLINCHCharacteristics of irreversible cell injury → nuclear pyknosis + membrane damage — the nucleus death sentence repeats.
TRAPReversible injury has a live nucleus.
TOPIC PACK — ENDOCRINE
12 items·2 pods
1Physiology of hormones and hypothalamic, hypophyseal axis
CHAINHypothalamus shouts, pituitary relays, gland delivers — the axis is a chain of command.
TRAPTrap: thinking the hypothalamus IS the pituitary.
2Pathophysiology of prolactin, prolactinoma with management, pathophysiology of growth hormones and acromegaly with management
STORYProlactinoma: galactorrhea + amenorrhea in a woman; macro = bitemporal hemianopia. Bromocriptine/cabergoline first.
TRAPTrap: acromegaly → 'surgery first' when the real first line for most is a somatostatin analogue pre-op.
3SIADH with management, thyroid gland overview and pathophysiology of thyroid hormones
CLINCHSIADH: euvolemic hyponatremia, urine concentrated, treat with fluid restriction. ADH up = water in.
TRAPTrap: SIADH vs cerebral salt wasting — CSW is hypovolemic and needs saline.
4Hyperthyroidism, Graves disease versus multi nodular goiter, thyroid storm, amiodarone induced thyroiditis type 1 and type 2
DANGERGraves = diffuse + orbitopathy + pretibial myxedema; MNG = nodular, no eye signs. Thyroid storm = fever + tachy + agitation, give PTU, iodine, beta-blocker.
TRAPTrap: amiodarone-induced type 1 (iodine-driven, treat with thionamide) vs type 2 (destructive thyroiditis, treat with steroids).
5Calcium regulation, hyperparathyroidism with types in detail and important table
PICTUREParathyroid: 'bones, stones, moans, groans' — hypercalcemia; primary hyperpara = single adenoma → remove; secondary = renal failure → treat kidney.
TRAPTrap: PTH high + calcium high = primary; PTH high + calcium low = secondary (vitamin D/renal).
6Hypothyroidism, Hashimoto thyroiditis, subacute thyroiditis, Riedel thyroiditis and congenital hypothyroidism
NUMBERHashimoto = autoimmune hypothyroid with goiter + anti-TPO; subacute = painful viral thyroiditis; Riedel = woody fibrous invasion.
TRAPTrap: congenital hypothyroidism → screening because the baby looks FINE at birth.
7Hypoparathyroidism with types, primary versus secondary hyperaldosteronism
STORYHypopara = post-thyroidectomy → tingling, Chvostek/Trousseau, low Ca low PTH, give calcium + vit D. Hyperaldosteronism: HTN + hypokalemia.
TRAPTrap: primary hyperaldosteronism (Conn, adrenal adenoma) vs secondary (renovascular — renin high).
8Physiology of cortisol, Cushing syndrome versus Cushing disease and dexamethasone suppression test
CLINCHCushing: cortisol excess. Disease = pituitary; syndrome = anywhere else. Dexamethasone suppression: low dose vs high dose distinguishes them.
TRAPTrap: 'Cushing disease' must mean pituitary, not just 'the patient has Cushing'.
9Multiple endocrine neoplasia, diabetes mellitus, DM1 versus DM2, DKA versus HHS
ACRONYMMEN: 2A = medullary thyroid + pheo + hyperpara; 2B adds marfanoid + neuromas. DKA = ketones + high anion gap; HHS = extreme glucose without ketones.
TRAPTrap: MEN1 = pituitary + parathyroid + pancreas (3P); MEN2 = thyroid + adrenal (2T+A).
10Management of diabetes mellitus in detail
NUMBERDM ladder: lifestyle → metformin → SGLT2/GLP1 → insulin. Metformin = first, avoids hypoglycemia, causes B12 deficiency.
TRAPTrap: metformin in eGFR<30 = lactic acidosis risk; stop before contrast.
11Adrenal insufficiency, primary versus secondary, acute versus chronic insufficiency and pheochromocytoma with management
DANGERAdrenal crisis = hypotension + low Na + high K → give hydrocortisone FIRST, before waiting for labs. Pheo: episodic HTN + headache/palpitations/sweat, 24h metanephrines.
TRAPTrap: never treat pheo with beta-blocker alone — unopposed alpha → crisis.
12Pathophysiology of anti diuretic hormones, psychogenic polydipsia versus CDI versus NDI
CLINCHPsychogenic polydipsia: low ADH but kidneys respond; CDI: no ADH — responds to desmopressin; NDI: kidneys deaf to ADH — does NOT respond.
TRAPTrap: water deprivation test — CDI concentrates urine with DDAVP, NDI does not.
TOPIC PACK — SURGERY
32 items·5 pods
1Shock, hypovolumic shock, cardiogenic shock and obstructive shock
DANGERShock ladder: hypovolemic (low preload), cardiogenic (pump failure), obstructive (tamponade/PE). Give fluids except cardiogenic/obstructive.
TRAPTrap: 'all shock needs fluids' — cardiogenic and obstructive need the cause fixed.
2Hemorrhage, causes, classification and management
NUMBERExsanguination math: class III = 30-40% blood loss, pulse >120, BP drops — transfuse, don't just crystalloid.
TRAPTrap: class I/II compensated may have normal BP — don't wait for hypotension.
3Distributive shock (anaphylactic shock, septic, neurogenic shock), and endocrine shock
STORYDistributive = vessels dilate: anaphylaxis (give epinephrine, not just steroids), sepsis, neurogenic (spinal cord). Endocrine shock = adrenal crisis.
TRAPTrap: anaphylaxis first-line = IM epinephrine — antihistamines are adjunct.
4Burn injuries, classification of burn and management
NUMBERBurn size by Rule of 9s; Parkland: 4 mL × kg × %TBSA in 24h, half in first 8h. Deep burns = no pain (nerve destruction).
TRAPTrap: Parkland for children needs maintenance fluid added; use Parkland, not just 'NS bolus'.
5Wound, types of wound, stages of wound healing and types of wound healing
CHAINWound healing: primary (clean edges), secondary (heals by granulation), tertiary (delayed closure). Phases: inflammation → proliferation → maturation.
TRAPTrap: 'primary intention = faster always' — infected wounds must heal secondarily.
6Scar, hypertrophic scar versus keloid, chronic leg ulcer, classification, venous, arterial and neuropathic ulcers
CLINCHKeloid = grows beyond margins (earlobe, dark skin); hypertrophic = stays within. Venous ulcer = gaiter area; arterial = toes, painful, absent pulses.
TRAPTrap: venous (elevate, compress) vs arterial (do NOT compress — worse ischemia).
7Decubitus ulcer, sinus, pilonidal sinus and fistula with types, enterocutaneous fistula and AV fistula
PICTURESinus = blind tract; fistula = two epithelial surfaces connected. Pilonidal = natal cleft hair; AV fistula = artery to vein (used for dialysis).
TRAPTrap: Crohn + perianal fistula → don't just excise, treat the Crohn.
8Acid base balance, metabolic acidosis and raised anion gap and normal anion gap metabolic acidosis
ACRONYMAnion gap = Na − (Cl + HCO3). High gap: MUDPILES. Normal gap: diarrhea, RTA, saline. Metabolic acidosis → Kussmaul breathing.
TRAPTrap: 'normal pH = no acidosis' — compensated metabolic acidosis has normal pH but low HCO3.
9Metabolic alkalosis, respiratory acidosis, respiratory alkalosis and surgical infection
CLINCHRespiratory acidosis = hypoventilation (COPD, sedation); respiratory alkalosis = hyperventilation. Surgical infection: cellulitis vs abscess — abscess needs drainage not just antibiotics.
TRAPTrap: 'abscess + antibiotics only' fails; source control is the cure.
10Cysts, true versus pseudocyst, dermoid versus epidermoid cysts and varicose vein, CEAP classification with management
CLINCHTrue cyst = epithelial lining; pseudocyst = no epithelial lining (pancreatic). Dermoid = skin elements; epidermoid = just epidermis. CEAP classifies varicose veins.
TRAPTrap: 'pseudocyst is smaller' — it's about lining, not size.
11Esophagus overview, achalasia, pseudoachalasia and diffuse esophageal spasm
PICTUREAchalasia: dysphagia BOTH solids and liquids, bird-beak on barium, manometry = failed LES relaxation. Pseudoachalasia = malignancy mimics.
TRAPTrap: 'solids only = achalasia' — achalasia affects liquids too (unlike mechanical stricture).
12Hiatal hernia in detail, Zenker diverticulum and Barrett esophagus with management
STORYHiatal hernia: sliding (GEJ above diaphragm) common; paraesophageal = surgical. Zenker = hypopharyngeal pouch, elderly, regurgitation of undigested food. Barrett = metaplasia → surveillance.
TRAPTrap: Zenker diverticulum is false (no muscle wall); pulsion = Zenker, traction = midesophageal.
13Overview of stomach, peptic ulcer disease (gastric ulcer versus duodenal ulcer), investigation treatment and dumping syndrome
CLINCHGastric vs duodenal ulcer: gastric = pain worse with food, higher cancer risk, normal/high acid in duodenal. Dumping after gastric surgery: early (hyperosmolar) vs late (reactive hypoglycemia).
TRAPTrap: 'food relieves pain' is duodenal; gastric ulcer pain is aggravated by food.
14Peptic ulcer disease complication, gastric cancer features, investigation and treatment
DANGERPUD complication: perforation → rigid board-like abdomen, free air under diaphragm on erect CXR. Gastric cancer: weight loss + epigastric pain, gastric outlet obstruction.
TRAPTrap: 'perforated ulcer needs antibiotics only' — laparotomy/repair is definitive.
15Extra intestinal features of IBD, short bowel syndrome, mesenteric ischemia, overview of appendix and acute appendicitis in detail
CLINCHCrohn = transmural, skip lesions, strictures/fistulas, terminal ileum; UC = mucosal, continuous, starts rectum. Mesenteric ischemia = pain out of proportion + AF or atherosclerosis.
TRAPTrap: 'appendicitis in elderly' — think tumor or ischemia first.
16Gastritis with types, primary versus secondary gastric MALT lymphoma and Crohn disease versus ulcerative colitis
STORYMALT lymphoma = H. pylori-driven gastric; eradicate H. pylori and the lymphoma can regress. Crohn vs UC: skip lesions + fistulas = Crohn.
TRAPTrap: 'MALT = always chemo' — H. pylori eradication first in early disease.
17Carcinoid tumor versus carcinoid syndrome, overview of anal canal and hemorrhage in detail with management
CLINCHCarcinoid: serotonin from midgut, flush + diarrhea + right-sided heart disease when liver mets bypass clearance. Anal canal: above pectinate = visceral (adenocarcinoma), below = squamous.
TRAPTrap: left-sided carcinoid doesn't flush (no liver bypass) — the flush means mets.
18Acute pancreatitis in detail with complication, management and chronic pancreatitis
DANGERAcute pancreatitis: gallstones + alcohol top the list; Ranson/Glasgow predict severity; amylase/lipase. Treat: fluids, analgesia, enteral feeding, NOT routine antibiotics.
TRAPTrap: 'give antibiotics for pancreatitis' — only for infected necrosis, otherwise no benefit.
19Anal fissure, anorectal abscess, fistula in ano, genital warts and other genital
CLINCHAnal fissure = painful bright-red bleeding with hard stool, posterior midline, treat with laxatives + GTN. Fistula in ano = prior abscess drainage track.
TRAPTrap: 'lateral fissure = benign' — lateral or multiple fissures → think Crohn/syphilis.
20Complication of cholecystitis, cholangitis, cholangiocarcinoma and undescended testes with management
DANGERCholecystitis: RUQ pain + fever + Murphy sign; complicated by empyema/gangrene, Mirizzi. Cholangitis = Charcot triad (pain, jaundice, fever) → urgent ERCP after resuscitation. Undescended testis → risk of malignancy.
TRAPTrap: cholangitis needs drainage (ERCP), not 'observe with antibiotics'.
21Pancreatic cancers in detail, cholelithiasis in detail and cholecystitis in detail
STORYPancreatic cancer: painless jaundice + weight loss + Courvoisier; head of pancreas. Cholelithiasis: asymptomatic gallstones can observe; symptomatic → cholecystectomy.
TRAPTrap: 'Courvoisier = always cancer' — it's a sign of obstruction, usually malignant but not absolute.
22Test explanation
CLINCHTest explanations separate facts from theory — know why, not just what.
TRAPTrap: treating explanation sections as skippable.
23Scrotal complaints - testicular torsion, epididymis orchitis versus torsion of testes, varicocele versus hydrocele
DANGERTorsion = sudden agonizing pain, adolescent, absent cremasteric, surgical emergency in hours. Epididymo-orchitis = fever + dysuria + preserved cremasteric. Varicocele = left-sided bag of worms, correctable infertility.
TRAPTrap: 'torsion vs epididymitis' — torsion has NO fever/urinary symptoms; time is testicle.
24Testicular cancers, germ cell versus non germ cell tumor, overview gland and benign prostatic hyperplasia (BPH)
CLINCHGerm cell tumors (seminoma vs non-seminoma) in young men; non-germ = lymphoma in elderly. BPH = obstructive LUTS in elderly men.
TRAPTrap: seminoma is radiosensitive; non-seminoma not — don't lump them.
25Renal stone in detail, ureteric stones and JJ stent
NUMBERRenal stone: flank pain + hematuria; <5mm passes spontaneously; ureteric stone at vesicoureteric junction. JJ stent bridges obstruction.
TRAPTrap: 'all stones pass' — >10mm or infected obstructed stone needs intervention.
26Prostate cancers in detail, DRE finding in prostate pathologies and male urethra with injuries
STORYProstate cancer: raised PSA + hard nodule + osteoblastic bone mets (sclerotic). DRE findings differentiate BPH vs cancer (hard, craggy). Urethral injuries: straddle (bulbar) vs fracture pelvis (membranous).
TRAPTrap: 'PSA high = cancer' — also high in BPH/prostatitis; biopsy confirms.
27Breast pathologies, overview of breast, fibroadenoma versus phyllodes tumor, mondor disease and breast cancers in detail
CLINCHFibroadenoma = mobile, painless, young women; phyllodes = large, rapid, leaf-like, needs wide excision. Mondor = thrombophlebitis of breast veins. Breast cancer: mass, skin changes, axillary nodes.
TRAPTrap: 'fibroadenoma in anyone = observe' — in >35 or growing, biopsy.
28Hospital management of burn (fluid management and wound care)
NUMBERBurn fluid: Parkland 4×kg×%TBSA, half in 8h; urine output goal 0.5-1 mL/kg/h is the real target. Wound care: early excision, infection control.
TRAPTrap: 'urine output is irrelevant' — it's the best perfusion monitor in burns.
29Hernia, inguinal hernia, direct versus indirect inguinal hernia with management
CLINCHInguinal hernia: indirect (lateral, congenital, passes through deep ring) vs direct (medial, acquired, bulges through Hesselbach). Indirect = the common one in children and young adults.
TRAPTrap: 'direct is more dangerous' — indirect has strangulation risk from narrow deep ring.
30Femoral hernia and IV fluid in detail
DANGERFemoral hernia: below inguinal ligament, more common in women, high strangulation risk — always repair. IV fluids: crystalloids first, colloids for specific loss.
TRAPTrap: 'femoral hernia is rare' — in women it's the commonest hernia type.
31Esophageal perforation, Boerhaave syndrome versus Mallory Weiss syndrome and esophageal cancers with TNM staging
CLINCHBoerhaave = full-thickness esophageal rupture (vomiting); Mallory-Weiss = mucosal tear (hematemesis, usually stops). Esophageal cancer: dysphagia → weight loss, SCC upper vs adenocarcinoma lower (Barrett).
TRAPTrap: 'Mallory-Weiss = surgery' — most stop spontaneously; Boerhaave needs urgent surgery.
32Imaging, ultrasound, barium studies, mammography, CT scan versus MRI and FAST scan
CHAINImaging ladder: ultrasound = fluid/gallstones/pregnancy; barium = mucosal/functional; CT = trauma/pancreas; MRI = soft tissue/brain; FAST = free fluid in trauma.
TRAPTrap: 'CT for everything' — eFAST is the trauma screen, CT is targeted after.
TOPIC PACK — APPLIED ANATOMY
29 items·5 pods
1Blood supply of brain (anterior and posterior circulation)
CHAINBrain blood: anterior circulation = internal carotid → MCA/ACA (frontal/parietal/temporal); posterior = vertebrobasilar → PCA (occipital, vision).
TRAPTrap: 'MCA supplies occipital' — occipital is PCA; MCA is lateral brain.
2Opening in base of skull and passing important structures
PICTURESkull base openings: cribriform (CN I), optic canal (CN II + ophthalmic artery), superior orbital fissure (III, IV, Va, VI), foramen ovale (V3), jugular foramen (IX, X, XI).
TRAPTrap: 'optic canal carries the ophthalmic vein' — vein goes through superior orbital fissure.
3Berry aneurysm
NUMBERBerry aneurysm: circle of Willis bifurcations, anterior communicating artery most common; rupture = thunderclap headache + SAH.
TRAPTrap: 'aneurysm = MC at middle cerebral' — ACom is the classic site.
4Cranial nerve (olfactory nerve and optic nerve)
CLINCHOlfactory = smell, anosmia with frontal trauma; optic = vision; papilledema = raised ICP, but 'normal disk = no raised ICP' is wrong in early stages.
TRAPTrap: 'CN I is motor' — it's purely sensory (special afferent).
5Oculomotor nerve, trochlear nerve and abducens nerve
ACRONYMOculomotor (III): 'down and out' eye, ptosis, dilated pupil; trochlear (IV): inability to look down and in (tilt head to compensate); abducens (VI): medial squint, lateral rectus palsy.
TRAPTrap: 'blown pupil = III palsy' vs Horner (miosis) — pupil sign differentiates.
6Trigeminal nerve, division and course
ACRONYMTrigeminal: V1 ophthalmic (corneal reflex afferent), V2 maxillary (cheek), V3 mandibular (motor to mastication). Herpes zoster ophthalmicus = V1, Hutchinson sign.
TRAPTrap: 'corneal reflex is CN VII' — afferent V1, efferent VII.
7Maxillary division, mandibular division of trigeminal nerve and facial nerve
CLINCHFacial nerve (VII): muscles of face + taste anterior 2/3 + tearing/salivation. LMN = whole half face (Bell); UMN = lower face only (forehead spared).
TRAPTrap: 'Bell palsy spares forehead' — NO, Bell (LMN) drops the whole side.
8Accessory nerve and hypoglossal nerve
NUMBERAccessory (XI): sternocleidomastoid + trapezius — shoulder shrug/head turn weakness; hypoglossal (XII): tongue deviates to weak side (protrusion).
TRAPTrap: 'tongue deviates away' — it deviates TOWARD the lesion/weak side.
9Clinical significance of DCMLT and course of spinothalamic tract
CLINCHDCML: fine touch, vibration, proprioception — ipsilateral, crosses at medulla. Spinothalamic: pain/temp — crosses at spinal cord level, contralateral.
TRAPTrap: 'DCML crosses at cord' — no, at the medulla (nucleus gracilis/cuneatus).
10Spino cerebellar tract
CLINCHSpinocerebellar: unconscious proprioception, ipsilateral; doesn't cross (mostly). Lesion → ataxia, not sensory loss.
TRAPTrap: 'spinocerebellar crosses' — it stays mostly ipsilateral.
11Overview of thorax, sternal angle and diaphragm with important contents of its hiatus
NUMBERSternal angle (T4): 2nd costal cartilage, bifurcation of trachea, azygos arch. Diaphragm hiatus: T8 IVC, T10 esophagus, T12 aorta.
TRAPTrap: 'aorta T10, esophagus T12' — reversed: aorta T12, esophagus T10.
12Facial nerve and vestibulocochlear nerve with clinical significance
CLINCHFacial nerve exits stylomastoid; taste to anterior 2/3 via chorda tympani; tear line via greater petrosal. Vestibulocochlear: hearing + balance, acoustic neuroma → hearing loss + tinnitus.
TRAPTrap: 'acoustic neuroma is VII' — it's VIII (schwannoma).
13Glossopharyngeal nerve and vagus nerve
NUMBERIX: taste posterior 1/3, gag afferent, carotid body/sinus; X: vagus, recurrent laryngeal → hoarseness (unilateral), both = airway emergency.
TRAPTrap: 'gag reflex via X only' — afferent is IX, efferent is X.
14Ascending tract versus descending tract and corticospinal tract with course
CLINCHCorticospinal: UMN, crosses at pyramidal decussation → contralateral spastic paralysis (UMN signs). Ascending vs descending tracts: know each by function + crossing level.
TRAPTrap: 'corticospinal = flaccid' — acute lesion flaccid, becomes spastic; LMN is flaccid.
15Function of corticospinal tract and course of dorsal columns medial lemniscus tract
CHAINDCML crosses at medulla → fine touch/vibration/proprioception contralateral cortex. Lesion below medulla = ipsilateral loss; above = contralateral.
TRAPTrap: 'Brown-Séquard' — ipsilateral DCML + contralateral spinothalamic.
16Flow of CSF and signs of raised ICP
CHAINCSF: lateral ventricles → foramen of Monro → 3rd → aqueduct → 4th → foramina Luschka/Magendie. Raised ICP: papilledema, Cushing response (HTN + bradycardia).
TRAPTrap: 'CSF absorbed at choroid plexus' — produced there, absorbed at arachnoid granulations.
17Brachial plexus, Erb palsy, Klumpke palsy and rotator cuff
ACRONYMBrachial plexus: Erb (C5-6) = waiter's tip, 'Erb-Duchenne'; Klumpke (C8-T1) = claw hand. Rotator cuff: supraspinatus (initiate abduction), infraspinatus (external rotation).
TRAPTrap: 'Erb = claw' — Erb is waiter's tip; Klumpke is claw.
18Thalamus in detail with nuclei and neck triangle
CLINCHThalamus = sensory relay (pain, touch, proprioception); nuclei matter for memory. Neck triangles: carotid triangle = carotid bifurcation, hypoglossal nerve.
TRAPTrap: 'thalamus = motor' — it's the sensory gateway (motor goes via internal capsule).
19Humerus fractures with nerve palsy, muscle of arm with innervation and overview of nerve distribution
PICTUREHumerus: surgical neck → axillary n. (deltoid, regimental badge); radial groove → radial n. (wrist drop); medial epicondyle → ulnar n. (claw).
TRAPTrap: 'radial = claw' — radial is wrist drop; ulnar is claw.
20Cubital fossa, boundaries, contents and muscle of anterior versus posterior compartment of forearm
ACRONYMCubital fossa: biceps tendon, brachial artery, median nerve (B-B-M from lateral). Forearm compartments: anterior = flexors (median/ulnar), posterior = extensors (radial).
TRAPTrap: 'median nerve is most superficial in cubital fossa' — it's deep to biceps aponeurosis.
21Overview of lower limb femoral triangle boundaries with content and clinical significant
ACRONYMFemoral triangle: NAVEL lateral to medial — nerve, artery, vein, empty, lymph. Clinical: femoral pulse, femoral hernia below inguinal ligament.
TRAPTrap: 'femoral artery is lateral to nerve' — nerve is the lateral-most.
22Wrist joint, carpal bones, blood supply of upper limb and palmar arches in hand
CLINCHCarpal bones: scaphoid (avascular necrosis after fall on outstretched hand), lunate (dislocates). Palmar arches: superficial from ulnar, deep from radial.
TRAPTrap: 'scaphoid fracture heals well' — proximal pole has poor blood supply → AVN.
23Lower limb - thigh region with compartments, leg region with compartments and nerve innervation with clinical significance
DANGERThigh/leg compartments: anterior leg = foot drop (deep fibular n.); posterior = plantar flexion (tibial n.); lateral = eversion (superficial fibular). Compartment syndrome = pain on passive stretch, urgent fasciotomy.
TRAPTrap: 'compartment syndrome = pulseless first' — pain and stretch are the early signs, pulses go late.
24Lower limb - popliteal fossa, Becker cyst, blood supply arterial versus venous drainage
CLINCHPopliteal fossa: roof = skin/fascia; contents = popliteal artery/vein, tibial + common fibular nerves. Baker cyst = popliteal swelling from knee effusion.
TRAPTrap: 'Baker cyst = sarcoma' — it's benign, but a DVT must be ruled out.
25Blood supply of chest wall (anterior and posterior side)
ACRONYMChest wall blood: anterior = internal thoracic (from subclavian), posterior = posterior intercostals from aorta. Intercostal neurovascular bundle runs in the costal groove (vein, artery, nerve, V-A-N).
TRAPTrap: 'VAN above rib' — it's below the rib (inferior border).
26Mediastinum types with contents, tracheobronchial tree and important MCQs on heart supply
CLINCHMediastinum: superior/anterior/middle (heart) /posterior (esophagus, aorta, vagus). Tracheobronchial tree: right main bronchus = wider, shorter, more vertical → aspiration goes right.
TRAPTrap: 'aspiration goes left' — right main bronchus is the usual site.
27Muscle of abdomen, blood supply of GIT viscera, venous drainage and portosystemic anastomosis
NUMBERAbdominal muscles: transversus abdominis (deep), internal oblique, external oblique (superficial, 'hands in pockets'). GIT blood: foregut celiac (T12), midgut SMA (L1), hindgut IMA (L3).
TRAPTrap: 'SMA supplies foregut' — celiac for foregut, SMA for midgut.
28Overview of perineum, pelvic diaphragm, urogenital diaphragm, deep perineal pouch versus superficial perineal pouch
CLINCHPerineum: pelvic diaphragm (levator ani + coccygeus), urogenital diaphragm (deep perineal pouch); superficial pouch = bulbospongiosus, ischiocavernosus.
TRAPTrap: 'deep pouch = external sphincter of urethra + transverse perinei' — correct, and that's the urogenital diaphragm.
29Overview of the exam (neuroanatomy)
CLINCHNeuroanatomy exam pattern: know tract crossing levels and cranial nerve exit points — the highest-yield discriminators.
TRAPTrap: 'surface anatomy over internal tracts' — tracts earn more marks.
TOPIC PACK — HEMATOLOGY
14 items·2 pods
1Overview of erythrocytes ( RBC ), and anemia with classification
CHAINRBC lifecycle 120 days; anemia = low Hb. Classify by MCV: micro (<80), normo (80-100), macro (>100) — this splits the whole branch.
TRAPTrap: 'anemia = iron deficiency' before looking at MCV.
2Iron deficiency anemia, anemia of chronic disease, sideroblastic anemia and lead poisoning
CLINCHIDA: microcytic, low ferritin, low iron, high TIBC — pica, koilonychia; treat with oral iron. Anemia of chronic disease: low iron, LOW TIBC, high ferritin. Sideroblastic: ring sideroblasts, lead poisoning dots.
TRAPTrap: 'ferritin low in both' — ACD ferritin is HIGH (acute phase).
3Non megaloblastic macrocytic anemia, normocytic anemias, intrinsic versus extrinsic, intravascular versus extravascular hemolysis and G6PD deficiency
CLINCHMegaloblastic macrocytic = B12/folate; B12 needs intrinsic factor (pernicious anemia, posterior columns). Non-megaloblastic macrocytic = liver, alcohol, hypothyroid. G6PD: hemolysis after fava/oxidants, Heinz bodies.
TRAPTrap: 'B12 deficiency = folate deficiency' — B12 also causes neuro deficits; folate does not.
4Thalassemia, alpha and beta thalassemia with types, megaloblastic anemia (folate deficiency, cobalamin deficiency and orotic aciduria)
CLINCHThalassemia: alpha (Hb Barts/hydrops), beta (HbF persistence, Mediterranean). B12/folate deficiency → megaloblastic. Orotic aciduria: megaloblastic but B12/folate NORMAL.
TRAPTrap: 'beta thalassemia major = too much HbA2/F' — it's about imbalanced globin chains, not simple low Hb.
5Paroxysmal nocturnal hemoglobinuria, hereditary spherocytosis and sickle cell anemia
STORYPNH: complement hemolysis, nocturnal, thrombosis, pancytopenia — eculizumab. Spherocytosis: MCHC high, osmotic fragility, splenomegaly, gallstones. Sickle: HbS, crisis + pain, avascular necrosis.
TRAPTrap: 'PNH = morning urine only' — it's chronic complement break; test is flow cytometry CD55/59.
6Autoimmune hemolytic anemia with types, MAHA, aplastic anemia, anemia in CKD and polycythemia with types
CLINCHAIHA: Coombs positive; warm (IgG, splenic) vs cold (IgM, agglutination). MAHA: schistocytes, TTP/HUS/DIC. Aplastic: pancytopenia, hypocellular marrow. Polycythemia: high RBC mass, JAK2, phlebotomy.
TRAPTrap: 'Coombs negative = not immune' — cold AIHA needs cold Coombs (4°C).
7Heparin, HIT-I versus HIT-II, heparin versus warfarin and aspirin
DANGERHeparin: binds antithrombin, monitor aPTT, antidote protamine. HIT: platelets DROP after 5-10 days, thrombosis — STOP heparin, use argatroban. Warfarin: inhibits vitamin K factors, monitor INR, antidote vitamin K.
TRAPTrap: 'HIT = bleeding' — HIT is a THROMBOTIC disorder, not bleeding.
8Thrombolytics, ADP receptor inhibitor, common chemotoxicities
CHAINThrombolytics: tPA for STEMI/PE/stroke — bleeding risk. ADP inhibitors: clopidogrel, prasugrel, ticagrelor. Chemo toxicity: doxorubicin cardiotox, bleomycin lung, cisplatin nephro/neuro, vincristine neuropathy.
TRAPTrap: 'all chemo = same toxicity' — each agent has its own signature organ.
9Porphyria, acute intermittent porphyria, porphyria cutanea tarda, steps of primary hemostasis and Bernard Soulier syndrome versus Glanzmann thrombasthenia
CLINCHPorphyria: acute intermittent (neuro + abdominal pain, 'PAS positive', avoid barbiturates) vs cutanea tarda (skin, uroporphyrin). Primary hemostasis: platelets + vWf — Bernard-Soulier (absent GPIb, platelets don't stick) vs Glanzmann (absent GPIIb/IIIa, platelets don't aggregate).
TRAPTrap: 'Bernard-Soulier vs Glanzmann' — B-S fails adhesion, Glanzmann fails aggregation.
10ITP, TTP, HUS, von Willebrand factor deficiency and coagulation cascades (intrinsic versus extrinsic pathway)
DANGERITP: isolated low platelets, antiplatelet antibody, treat steroids/IVIG. TTP: pentad fever, neuro, renal, thrombocytopenia, MAHA — ADAMTS13 deficiency, PLASMAPHERESIS. HUS: E. coli O157, diarrhea, renal. vWD: factor VIII + vWF, bleeding, DDAVP.
TRAPTrap: 'TTP = steroids' — TTP needs urgent plasmapheresis; steroids alone are too slow.
11Hemophilia with types, acquired hemophilia, hypercoagulation disorder (protein C and S deficiency versus factor Leiden), and DIC
CLINCHHemophilia A = factor VIII (X-linked), hemarthrosis; B = factor IX. DIC: consumption coagulopathy, low platelets + high PT/PTT + high D-dimer, treat underlying cause. Protein C/S, Factor V Leiden: venous thrombosis, hypercoagulable.
TRAPTrap: 'DIC treatment = heparin always' — only in select cases; the core is treating the cause.
12ALL, AML, CML, CLL, Hodgkin lymphoma and non Hodgkin lymphoma
STORYALL: children, B-cell precursor, 'blasts', good prognosis; AML: adults, Auer rods; CML: BCR-ABL Philadelphia chromosome, imatinib; CLL: elderly, smudge cells, 'lymphocytosis'.
TRAPTrap: 'ALL in adults poor' — ALL is childhood leukemia; CLL/AML dominate adults.
13Burkitt lymphoma, diffuse large B cell lymphoma, multiple myeloma, MGUS and Waldenstrom macroglobulinemia
ACRONYMBurkitt: MYC translocation, jaw mass, 'starry sky'; DLBCL: most common NHL, curable; Multiple myeloma: CRAB (calcium, renal, anemia, bone), M spike, rouleaux; MGUS: pre-malignant, observe; Waldenstrom: IgM, hyperviscosity.
TRAPTrap: 'MGUS = treat' — MGUS is watched, not treated.
14Myeloproliferative disorder, important table, blood groups and transfusion reaction with types, TACO versus TRALI
CLINCHMyeloproliferative: polycythemia vera (JAK2, phlebotomy), ET (platelets), myelofibrosis (marrow fibrosis, splenomegaly). Blood groups: ABO crossmatch, Rh. Transfusion reaction: acute hemolytic (ABO mismatch, immediate) vs TRALI (ARDS after transfusion) vs TACO (fluid overload).
TRAPTrap: 'TACO vs TRALI' — TRALI = respiratory distress + leukocyte antibodies; TACO = volume overload, responds to diuresis.
TOPIC PACK — MUSCULOSKELETAL
4 items·1 pod
1Spinal stenosis, bone tumours with detail, overview of arthritis
CLINCHSpinal stenosis: neurogenic claudication, relieved by leaning forward — 'shopping cart sign'. Bone tumors: osteosarcoma (young, distal femur), Ewing (young, diaphysis, onion skin), myeloma (elderly). Arthritis: inflammatory vs degenerative.
TRAPTrap: 'osteosarcoma in elderly' — it's adolescents/young adults; elderly = metastasis or myeloma.
2Ankylosing spondylitis, seronegative arthritis and systemic lupus erythematous in detail
CLINCHAnkylosing spondylitis: young male, back pain, HLA-B27, bamboo spine, uveitis; treat NSAIDs (indomethacin), anti-TNF. Seronegative: Reiter (conjunctivitis, urethritis, arthritis), psoriatic, IBD-associated. SLE: female, malar rash, anti-dsDNA, photosensitivity.
TRAPTrap: 'AS = rheumatoid factor positive' — seronegative means RF negative.
3Osteoarthritis versus rheumatoid arthritis, Sjogren syndrome and gout versus pseudogout
ACRONYMOA: asymmetric, weight-bearing, Heberden nodes, no systemic features. RA: symmetric, small joints, morning stiffness >1h, anti-CCP, erosions. Sjogren: dry eyes/mouth, anti-Ro/La, lymphoma risk. Gout: urate crystals, podagra; pseudogout: CPPD, chondrocalcinosis.
TRAPTrap: 'gout = pyrophosphate' — gout is monosodium urate, pseudogout is CPPD.
4Behcet syndrome Takayasu arteritis versus temporal arteritis, polymyositis versus dermatomyositis and fibromyalgia versus PMR
DANGERBehcet: oral + genital ulcers, uveitis. Takayasu (young Asian female, pulseless) vs temporal arteritis (elderly, headache, jaw claudication, ESR high, steroids NOW). Polymyositis/dermatomyositis: proximal weakness, heliotrope, anti-Jo1. Fibromyalgia vs PMR: tender points vs shoulder/hip stiffness + high ESR.
TRAPTrap: 'TA = watch ESR before treating' — if temporal arteritis suspected, DON'T wait, start steroids.
TOPIC PACK — GYNECOLOGY
8 items·2 pods
1Normal female development, menstrual cycle in detail, safe versus unsafe days
STORYMenstrual cycle: follicular (estrogen, FSH) → ovulation (LH surge) → luteal (progesterone). Safe days = after ovulation, before menses; ovulation = day 14 in 28-day cycle.
TRAPTrap: 'safe days = just after menses' — sperms survive 5 days, unsafe window widens.
2Primary amenorrhea and secondary amenorrhea in detail
CLINCHPrimary amenorrhea = never menstruated by 15 (or 3y post-thelarche) — rule out imperforate hymen, Turner, MRKH. Secondary = cessation ≥3 cycles/6 months — pregnancy FIRST.
TRAPTrap: 'secondary amenorrhea workup before pregnancy test' — ALWAYS rule out pregnancy first.
3Primary versus secondary dysmenorrhea, endometriosis versus adenomyosis
CLINCHDysmenorrhea: primary = no pathology, prostaglandins, NSAIDs; secondary = endometriosis, fibroids, adenomyosis. Endometriosis = endometrial tissue outside uterus, pain with menses, chocolate cyst; adenomyosis = endometrium INSIDE myometrium, bulky tender uterus.
TRAPTrap: 'adenomyosis = outside the uterus' — it's within the wall, endometriosis is outside.
4Contraceptive methods, hormonal methods, IUCD, barrier methods, permanent methods and emergency pill
DANGERContraception ladder: combined oral (estro+progest), progestin-only (breastfeeding), IUCD (Cu = 10yr, LNG = 5yr), barrier (condom), permanent (tubal ligation), emergency (levonorgestrel within 72h, or Cu-IUCD up to 5 days).
TRAPTrap: 'emergency pill = abortion' — it prevents ovulation/fertilization, not established pregnancy.
5Congenital adrenal hyperplasia with important table and infertility
STORYCAH: 21-hydroxylase deficiency, virilization, salt wasting, ↑17-OHP. Infertility: female (anovulation, tubal, endometriosis) vs male (sperm, varicocele) → workup systematically.
TRAPTrap: 'CAH = only virilization' — salt-wasting crisis in neonates is life-threatening.
6Vaginitis in detail with types and urinary incontinence in detail with types
CLINCHVaginitis: candida (white curd, itch), trichomonas (frothy, strawberry cervix, motile), bacterial vaginosis (fishy, clue cells, thin grayish). Urinary incontinence: stress (leaks with cough, SUI → sling), urge (overactive bladder, anticholinergics), overflow (retention).
TRAPTrap: 'BV = treat partner' — BV is NOT sexually transmitted; trichomonas is.
7PCOS, toxic shock syndromes and pelvic organ prolapse
DANGERPCOS: oligomenorrhea + hyperandrogenism + polycystic ovaries, insulin resistance, treat with metformin + lifestyle. TSS: tampons + fever + rash + shock, S. aureus. Pelvic organ prolapse: cystocele, rectocele, uterine prolapse grading.
TRAPTrap: 'TSS = strep' — it's Staphylococcus aureus, toxin-mediated.
8Fibroid, types, gynecological cancer, endometrial carcinoma and ovarian cancer
DANGERFibroids: leiomyomas, heavy bleeding, menorrhagia, intramural/submucosal/subserosal. Endometrial carcinoma: postmenopausal bleeding, most common gyn cancer, treat surgery. Ovarian cancer: silent, late, CA-125, BRCA. Cervical cancer: HPV 16/18, Pap smear, SCC.
TRAPTrap: 'ovarian = early diagnosis' — ovarian is the SILENT killer, found late; cervical has screening.
TOPIC PACK — CARDIOVASCULAR
13 items·2 pods
1Overview of heart, chambers, valve, septum, auscultation site of heart valve heart sounds in detail
PICTUREHeart valves: aortic (right 2nd intercostal), pulmonary (left 2nd), tricuspid (left 4th), mitral (left 5th midclavicular). S1 = AV close; S2 = semilunar close.
TRAPTrap: 'tricuspid = left side' — tricuspid is best heard at LEFT lower sternal border, but it's the RIGHT-sided valve.
2Cardiac output with factors, EDV, ESV, ejection fraction
CHAINCardiac output = HR × SV; EDV (preload), ESV (afterload); EF = SV/EDV (>55% normal). Frank-Starling: ↑preload → ↑contractility to a limit.
TRAPTrap: '↑HR always = ↑CO' — too fast → ↓filling → ↓CO.
3Conducting system of heart, electrocardiogram (ECG), and JVP waveform in detail
CLINCHSA node = primary pacemaker; AV delays; bundle branches; Purkinje fast. ECG: P wave (atrial depolarization), QRS (ventricles), T (repolarization). JVP: reflects right atrial pressure; cannon a waves in AV dissociation.
TRAPTrap: 'QRS = atrial depolarization' — QRS is VENTRICULAR, P is atrial.
4Actions potential of heart, action potential of SA node versus AV node and baroreceptors versus chemoreceptors
CLINCHCardiac action potential: phase 0 (Na), 1 (K transient), 2 (Ca plateau), 3 (K repolarization), 4 (pacemaker). SA/AV nodes = Ca-dependent (phase 4 slow), ventricles = Na-dependent. Baroreceptors = pressure, chemoreceptors = O2/CO2/pH.
TRAPTrap: 'pacemaker = Na-based' — SA/AV nodes are Ca-dependent; that's why CCBs slow them.
5Rheumatic fever and Jones criteria, infective endocarditis and Duke criteria
CLINCHRheumatic fever: Jones criteria — carditis, arthritis, chorea, erythema marginatum, subcutaneous nodules; treat penicillin. Infective endocarditis: Duke criteria — fever, new murmur, emboli, blood cultures; treat long antibiotics, surgery if abscess.
TRAPTrap: 'RF = only arthritis in adults' — carditis is the severe manifestation.
6Dilated cardiomyopathy, HOCM, restrictive cardiomyopathy and cardiac tamponade
DANGERDilated CM: LV dilation, systolic failure, 'poor squeeze'; HOCM: asymmetric septal hypertrophy, LVOT obstruction, sudden death in young athletes; restrictive: stiff ventricle, diastolic failure; tamponade: ↓CO, ↓BP, ↑CVP, pulsus paradoxus, treat by pericardiocentesis.
TRAPTrap: 'HOCM = give digoxin' — digoxin worsens obstruction; beta-blockers/CCBs are used.
7Acute pericarditis, aortic dissection and ischemic heart diseases (stable angina, unstable angina and prinzmetal angina)
CLINCHAcute pericarditis: chest pain relieved by leaning forward, PR depression + diffuse ST elevation. Aortic dissection: tearing chest pain radiating to back, BP difference between arms — CT aorta, urgent surgery type A. Ischemic heart disease: stable angina (predictable, relieved by rest/nitroglycerin), unstable (new/worsening, rest pain), prinzmetal (ST elevation, vasospasm, CCB).
TRAPTrap: 'pericarditis pain = worse leaning forward' — it's RELIEVED by leaning forward, worse lying flat.
8Myocardial infarction, types with artery ECGs changes, cardiac markers, and left sided heart failure versus right side heart failure
DANGERMI: STEMI (ST elevation, artery-specific ECG changes, treat with PCI/thrombolysis) vs NSTEMI (troponin rise). Markers: troponin = most specific, CK-MB (early, re-infarction), LDH (late, nonspecific). Left heart failure: pulmonary congestion (dyspnea, crackles); right: peripheral edema, JVD, hepatomegaly.
TRAPTrap: 'troponin rises late' — troponin rises in 3-4h, peak 12-24h; it's not late, LDH is late.
9HFref versus HFpef, NYHA classification and management of heart failure in detail
CLINCHHFrEF (EF <40%): ACEi/ARB + beta-blocker + spironolactone + SGLT2i; HFpEF (EF ≥50%): control BP, diuretics. NYHA class I-IV: symptoms with exertion → rest. Treat heart failure: diuretics for congestion, beta-blockers (cautious), digoxin for AF.
TRAPTrap: 'beta-blockers contraindicated in HF' — they're LIFE-PROLONGING in stable HFrEF.
10Heart blocks with types in detail and valvular heart diseases with cardiac murmurs in detail
CLINCHHeart blocks: 1st (PR prolonged), 2nd (Mobitz I Wenckebach = benign; Mobitz II = dangerous, needs pacemaker), 3rd (complete AV dissociation, wide QRS, hypotension — pacemaker). Valvular: aortic stenosis (syncope, angina, heart failure, crescendo-decrescendo), aortic regurg (diastolic, water hammer), mitral stenosis (opening snap), mitral regurge (pansystolic).
TRAPTrap: 'Mobitz I = pacemaker' — Mobitz I (Wenckebach) watches; Mobitz II needs pacing.
11Atrial flutter versus atrial fibrillation, management of atrial fibrillation in detail, dyslipidemia and lipid lowering drugs
CLINCHAtrial flutter: sawtooth 300/min atrial rate with AV block; AFib: irregularly irregular, no P waves, anticoagulate (CHA₂DS₂-VASc). Dyslipidemia: LDL target depends on risk; statins = first line. Lipid lowering: statins (HMG-CoA), ezetimibe, PCSK9.
TRAPTrap: 'AFib = regular rhythm' — it's irregularly irregular; flutter is regular.
12Anti arrhythmic agents (class 1, class 2, class 3 and class 4)
ACRONYMAntiarrhythmics: Class 1 (Na channel — 1A quinidine, 1B lidocaine, 1C flecainide), Class 2 (beta-blockers), Class 3 (K channel — amiodarone, sotalol), Class 4 (CCB — verapamil/diltiazem).
TRAPTrap: 'amiodarone = Na channel' — amiodarone is Class 3 (K channel) with multiple effects.
13Cardiac glycosides (digoxin, nitrates, cardiac tumour and important points)
DANGERDigoxin: ↑inotropy, ↓AV conduction — treat AF rate control + HF; toxicity (vomiting, yellow vision, arrhythmia) with hypokalemia. Nitrates: venodilation, ↓preload, headache, tolerance. Cardiac tumors: myxoma = most common primary, mobile, 'plop', emboli.
TRAPTrap: 'digoxin toxicity = hyperkalemia' — hypokalemia INCREASES digoxin effect/toxicity.
TOPIC PACK — OBSTETRICS
7 items·1 pod
1Definition, basic terminologies, GPA versus GTPAL, labor with stages, EDD and fetal period
ACRONYMGPA/GTPAL: G = number of pregnancies, P = births, A = abortions; GTPAL (term, preterm, abortions, living). Labor: 1st stage (cervical dilation to 10cm), 2nd (delivery), 3rd (placenta); EDD = Naegele: LMP + 7 days − 3 months.
TRAPTrap: 'GTPAL G includes current pregnancy' — yes, G counts ALL including current; that's the common slip.
2Chronic HTN, gestational HTN, preeclampsia, eclampsia, HELLP syndrome and ectopic pregnancy
DANGERChronic HTN: before 20 weeks; gestational: after 20 weeks NEW; preeclampsia: HTN + proteinuria (headache, epigastric, visual changes); eclampsia: + seizures — magnesium sulfate. HELLP: hemolysis, elevated liver enzymes, low platelets → deliver. Ectopic: pain + bleeding after amenorrhea, adnexal mass, β-hCG + no intrauterine pregnancy on ultrasound.
TRAPTrap: 'eclampsia = treat BP only' — magnesium sulfate is THE anticonvulsant; BP control alone won't stop seizures.
3Gestational diabetes mellitus (OGTT test), placental abnormalities, abruptio placentae versus placenta previa
CLINCHGDM: OGTT at 24-28 weeks, screen all, treat with diet ± insulin. Placental abnormalities: placenta previa (painless bleeding, low-lying) vs abruptio placentae (painful, retroplacental clot, fetal distress).
TRAPTrap: 'prev1a = abruption' — previa is PAINLESS, abruption is PAINFUL.
4Abortion with types and spontaneous abortion with types in detail and post partum hemorrhage in detail
ACRONYMAbortion types: threatened (bleeding, cervix closed), inevitable (bleeding, cervix open), incomplete (products retained, bleeding persists), missed (fetal death, no expulsion, D&C). PPH: >500mL vaginal, >1000mL cesarean; causes = 4 Ts (tone, trauma, tissue, thrombin); treat: uterine massage, uterotonics (oxytocin), misoprostol.
TRAPTrap: 'PPH = only uterine atony' — the 4 Ts: tone, trauma, tissue, thrombin — atony is just #1.
5Sheehan syndrome, breast feeding, bottle feeding and mastitis
STORYSheehan: postpartum pituitary necrosis after massive PPH — failure to lactate, amenorrhea, hypopituitarism. Breastfeeding: exclusive 6 months, benefits both. Bottle feeding: formula. Mastitis: S. aureus, fever + red breast, antibiotics + continue breastfeeding.
TRAPTrap: 'mastitis = stop breastfeeding' — CONTINUE breastfeeding/emptying, antibiotics, warm compress.
6Molar pregnancy complete mole versus incomplete mole, fetal malpresentation and Rh incompatibility
CLINCHMolar pregnancy: complete (46XX all paternal, no fetal tissue, high β-hCG, snowstorm ultrasound) vs partial (69XXY triploid, some fetal tissue). Malpresentation: breech — external cephalic version, C-section if persistent. Rh incompatibility: Rh− mother with Rh+ baby → anti-D given at 28 weeks + after birth.
TRAPTrap: 'complete mole has fetal parts' — complete mole has NO fetal tissue; partial does.
7Shoulder dystocia, C-Section in detail and amniotic fluid (oligohydramnios versus polyhydromnios)
DANGERShoulder dystocia: head delivers, shoulders stuck — McRoberts maneuver, suprapubic pressure, call for help. C-section: indications (fetal distress, previa, malpresentation, failed induction). Amniotic fluid: oligohydramnios (too little, renal issues, fetal compression) vs polyhydramnios (too much, GDM, esophageal atresia, neural tube defects).
TRAPTrap: 'shoulder dystocia = pull harder' — NEVER pull; McRoberts + suprapubic pressure.
TOPIC PACK — RENAL
8 items·2 pods
1Embryology of kidney, horseshoe kidney and Potter sequence
STORYKidney embryology: pronephros → mesonephros → metanephros (permanent). Horseshoe kidney: isthmus at L3, associated with Wilms, asymptomatic. Potter sequence: oligohydramnios → pulmonary hypoplasia + limb deformities + renal agenesis (bilateral).
TRAPTrap: 'horseshoe = frequent UTI only' — also linked to Wilms tumor and stones.
2Fluid compartments, Starling forces for GFR, glucose clearance and tubular reabsorption (PCT)
CLINCHFluid compartments: 2/3 ICF, 1/3 ECF; Starling forces determine GFR (glomerular hydrostatic > oncotic). Glucose clearance: filtered then reabsorbed (splay when exceeded, glycosuria = DM). PCT reabsorbs: Na, glucose, amino acids, water, HCO3.
TRAPTrap: 'all glucose is reabsorbed at DCT' — bulk reabsorption is at PCT via SGLT2.
3Tubular reabsorption in detail with clinical significance
CLINCHTubular reabsorption details: PCT (Na, glucose, HCO3, H2O), loop of Henle (countercurrent, Ca/Mg), DCT (NaCl, Ca via PTH), collecting duct (ADH water, aldosterone Na/K). Clinical: loop diuretics work at thick ascending limb.
TRAPTrap: 'ADH acts at PCT' — ADH acts at collecting duct; PCT reabsorbs constitutively.
4Renal syndrome (Fanconi syndrome, Bartter syndrome, Gittle, Liddle and renal tubular acidosis, (RTA-I, II and IV)
CLINCHFanconi (generalized PCT dysfunction: glycosuria + aminoaciduria + phosphaturia), Bartter (loop defect, hypokalemic alkalosis + hypercalciuria), Gitelman (DCT defect, hypocalciuria), Liddle (ENaC gain, HTN + hypokalemia + LOW aldosterone). RTA types: I (distal, stones), II (proximal, HCO3 wasting), IV (aldosterone deficiency, hyperkalemia).
TRAPTrap: 'Bartter vs Gitelman by calcium' — Bartter = hypercalciuria, Gitelman = hypocalciuria.
5Nephrotic syndrome, minimal change disease, FSGS, membranous nephropathy, renal amyloidosis and diabetic nephropathy
CLINCHNephrotic: proteinuria >3.5g, edema, hypoalbuminemia, hyperlipidemia — minimal change (children, steroids), FSGS (most common in adults, HIV), membranous (PLA2R, anti-PLA2R, adults), diabetic nephropathy (microalbuminuria screen).
TRAPTrap: 'minimal change = adults' — minimal change is CHILDREN; FSGS/membranous are adult.
6Nephritic syndrome, PSGN versus IgA nephropathy, HSP, GPA, MPA, EGPA and anti GBM diseases
CLINCHNephritic: hematuria, RBC casts, HTN, oliguria. PSGN: post-strep, low C3, children; IgA nephropathy: after URI, hematuria, normal complement; HSP: purpura + arthritis + abdominal pain + IgA; GPA: c-ANCA, lung+renal; MPA: p-ANCA; anti-GBM: Goodpasture, lung+renal, linear IF.
TRAPTrap: 'low C3 in IgA' — IgA has NORMAL complement; PSGN has LOW C3.
7Acute kidney injury, pre renal failure, intrinsic renal failure, post renal failure, chronic renal failure and poly cystic kidney disease
NUMBERAKI: prerenal (BUN:Cr >20, low urine Na, FENa<1), intrinsic (ATN, casts, FENa>1), postrenal (obstruction, hydronephrosis). CKD: GFR<60 for 3 months, complications (anemia, bone, CVS) → manage all. ADPKD: polycystic, HTN, berry aneurysms, flank pain, family history.
TRAPTrap: 'FENa >1 = prerenal' — prerenal is FENa <1; >1 = intrinsic ATN.
8Hydronephrosis, renal cell carcinoma, urinary bladder cancers and pharmacology of diuretics
CLINCHHydronephrosis: obstruction anywhere — stones, tumor, BPH; US shows dilated pelvis. RCC: classic triad hematuria, flank pain, mass; clear cell, VHL association, paraneoplastic (erythropoietin = polycythemia). Bladder cancer: painless hematuria, smoking, TCC, urothelial. Diuretics: loop (furosemide — thick ascending), thiazide (DCT), K-sparing (collecting duct, spironolactone), osmotic (mannitol), CA inhibitors (acetazolamide).
TRAPTrap: 'loop = most potent but thiazide better for Ca' — loop causes hypercalciuria; thiazides REDUCE calcium (good for stones).
TOPIC PACK — GASTROENTEROLOGY
12 items·2 pods
1Foregut, midgut, hindgut esophagus
CHAINForegut = celiac artery (stomach, duodenum to ampulla, liver, spleen): midgut = SMA (jejunum to proximal transverse colon); hindgut = IMA (distal transverse to rectum).
TRAPTrap: 'duodenum = midgut' — duodenum is FOREGUT; midgut starts at the ampulla/ligament of Treitz.
2Secretory products and GIT regulatory substances
CLINCHSecretory products: stomach (HCl, pepsin, intrinsic factor), pancreas (bicarb, enzymes), small intestine (brush border). Regulatory: gastrin (G cells — ↑acid), CCK (gallbladder contraction, pancreatic enzyme release), secretin (↑bicarb), motilin (migrating motor complex).
TRAPTrap: 'CCK = acid secretion' — CCK is for gallbladder/pancreas; gastrin is for acid.
3Bile, bile acid, bile salt and types of bile
CLINCHBile: made in liver, stored in gallbladder, emulsifies fat. Bile acids: cholic, chenodeoxycholic (primary, from cholesterol); deoxycholic, lithocholic (secondary, bacterial in gut). Bile salts = conjugated bile acids — enterohepatic circulation.
TRAPTrap: 'bile made in gallbladder' — bile is MADE in the liver; gallbladder only stores/concentrates.
4Function of bile, fate of bilirubin and layer of GIT
CLINCHFunctions of bile: fat digestion/absorption, cholesterol excretion, bilirubin excretion. Bilirubin fate: unconjugated (indirect, albumin-bound) → liver conjugation (direct) → bile → gut → urobilinogen → stercobilin (brown stool). GIT layers: mucosa, submucosa, muscularis, serosa.
TRAPTrap: 'unconjugated is water soluble' — unconjugated is fat-soluble/albumin-bound; CONJUGATED is water-soluble.
5Esophageal cancer, acute versus chronic gastritis and peptic ulcer diseases
CLINCHEsophageal cancer: SCC (upper 2/3, smoking/alcohol) vs adenocarcinoma (lower, Barrett). Gastritis: acute (NSAIDs, stress, steroids) vs chronic (H. pylori, autoimmune). PUD: gastric (pain with food) vs duodenal (pain relieved by food, nocturnal).
TRAPTrap: 'adenocarcinoma = upper' — adenocarcinoma is LOWER (Barrett esophagus).
6Lactose intolerance, pancreatic insufficiency, Whipple disease, IBD (Crohn versus ulcerative colitis)
CLINCHLactose intolerance: lactase deficiency — osmotic diarrhea, bloating, trisaccharide tests. Pancreatic insufficiency: fat malabsorption (steatorrhea), CF, chronic pancreatitis. Whipple: Tropheryma whipplei, arthralgia + diarrhea + neuro, PAS-positive macrophages. IBD: Crohn (skip lesions, transmural, strictures) vs UC (continuous, mucosal, bloody).
TRAPTrap: 'Crohn = bloody diarrhea' — UC is the bloody one; Crohn often non-bloody with fistulas.
7Mesenteric ischemia and acute appendicitis with Alvarado score
CLINCHMesenteric ischemia: pain out of proportion, AF or atherosclerosis, lactate high — CT angiography, urgent revascularization. Acute appendicitis: periumbilical → RLQ pain, fever, Alvarado score >7 → appendectomy.
TRAPTrap: 'appendicitis starts in RLQ' — it starts PERIUMBILICAL then localizes to McBurney point.
8Diverticulum, Meckel diverticulum
NUMBERDiverticulum: outpouching — true (all layers, congenital, Meckel) vs false (mucosa + submucosa only, acquired, colonic). Meckel: 2 feet from ileocecal valve, 2% of population, 2 inches, more common in males <2 years, contains ectopic gastric tissue → bleeding.
TRAPTrap: 'Meckel is false diverticulum' — Meckel is a TRUE diverticulum (all layers); colonic are false.
9Pancreatic adenocarcinoma, acid suppression therapy, (proton pump inhibitors and H2 blockers)
CLINCHPancreatic adenocarcinoma: painless jaundice, weight loss, Courvoisier sign, CA19-9, poor prognosis. Acid suppression: PPIs (omeprazole, irreversible H+/K+ ATPase, better acid control, long-term concerns) vs H2 blockers (ranitidine, famotidine, reversible H2).
TRAPTrap: 'H2 blockers = irreversible' — PPIs are irreversible (covalent), H2 are reversible.
10Antacid, bismuth, misoprostol, sulfasalazine and anti emetics agents
DANGERAntacids: rapid but short-lived neutralization. Bismuth: coats ulcer, treats H. pylori, black stools. Misoprostol: PGE1 analogue, prevents NSAID ulcers, contraindicated in pregnancy. Sulfasalazine: IBD, 5-ASA. Antiemetics: ondansetron (5-HT3), metoclopramide (dopamine), scopolamine (muscarinic).
TRAPTrap: 'misoprostol for peptic ulcer in pregnancy' — contraindicated (abortifacient).
11Overview of esophagus, esophagitis with types, approach to dysphagia, achalasia with diffuse esophageal spasm
CLINCHEsophagitis: reflux (GERD), infectious (candida in immunocompromised — white plaques, HSV — ulcers, CMV). Dysphagia: oropharyngeal (sensation in neck, neurogenic) vs esophageal (chest, mechanical). Achalasia: no LES relaxation, bird-beak; DES: tertiary contractions, 'corkscrew'.
TRAPTrap: 'dysphagia = always esophageal' — oropharyngeal dysphagia is a distinct neuro/muscle problem.
12Zenker diverticulum, GERD with alarm symptoms and approach to GERD
DANGERZenker: hypopharyngeal pouch, elderly, regurgitation of undigested food, false diverticulum. GERD: heartburn, regurgitation; ALARM symptoms (dysphagia, weight loss, anemia, bleeding, age>55) → endoscopy; treat lifestyle + PPI.
TRAPTrap: 'GERD alarm = just more PPI' — alarm symptoms demand endoscopy to rule out cancer.
TOPIC PACK — HEPATOLOGY
5 items·1 pod
1Overview of liver, hepatitis with types and serological markers of hepatitis
CLINCHLiver: largest organ, synthetic (albumin, clotting), metabolic (glucose, ammonia), detox (drugs). Hepatitis: A (fecal-oral, acute), B (parenteral/sexual, chronic risk, HBsAg, anti-HBs), C (blood, chronic), D (delta, needs B), E (fecal-oral, pregnancy danger). Serology: HBsAg = active, anti-HBc IgM = acute, anti-HBs = recovered/vaccinated.
TRAPTrap: 'anti-HBs = acute infection' — anti-HBs is RECOVERY/vaccine; anti-HBc IgM is acute.
2Hemochromatosis, Wilson disease and cirrhosis of liver
CLINCHHemochromatosis: iron overload (bronze skin, diabetes, cirrhosis, heart), HFE gene, transferrin saturation, venesection. Wilson: copper (Kayser-Fleischer rings, neuro, hepatitis), low ceruloplasmin, penicillamine. Cirrhosis: fibrosis + nodular regeneration, complications (portal HTN, ascites, encephalopathy, varices, HCC).
TRAPTrap: 'Wilson = high ceruloplasmin' — Wilson = LOW ceruloplasmin; high is pregnancy/estrogen.
3Acute pancreatitis, Ranson criteria and chronic pancreatitis with managements
CLINCHAcute pancreatitis: gallstones + alcohol, epigastric pain radiating to back, elevated lipase >3×; Ranson criteria (11, at admission + 48h — age, WBC, glucose, LDH, AST, Ca, Hct, BUN, PaO2, base deficit, fluid sequestration). Chronic: recurrent pain, steatorrhea, diabetes, calcification — pancreatic enzymes.
TRAPTrap: 'pancreatitis severity = lipase level' — severity is CLINICAL + Ranson score, not enzyme height.
4Serum ascitic albumin gradient (SAAG), complications of cirrhosis and Budd Chiari syndrome versus portal vein thrombosis
CLINCHSAAG: >1.1 g/dL = portal HTN (cirrhosis, Budd-Chiari); <1.1 = non-portal (TB, malignancy, nephrotic). Cirrhosis complications: variceal bleed (banding, TIPS), ascites (paracentesis, TIPS), encephalopathy (lactulose, rifaximin), HCC (screening ultrasound). Budd-Chiari = hepatic vein thrombosis (ascites + tender liver); portal vein thrombosis = splenomegaly + varices.
TRAPTrap: 'Budd-Chiari = portal vein clot' — Budd-Chiari = HEPATIC vein (outflow) block; portal vein thrombosis is different.
5Non alcoholic fatty liver disease (NAFLD), autoimmune hepatitis, liver tumours, gall bladder and CBD pathologies
DANGERNAFLD: fat without alcohol, metabolic syndrome, → NASH → cirrhosis; treat weight loss. Autoimmune hepatitis: female, ANA/anti-SMA, interface hepatitis, steroids. Liver tumors: HCC (cirrhosis, AFP, treatment by resection/TACE/transplant). Gallbladder: cholecystitis (Murphy). CBD pathology: cholangitis (Charcot triad), stones.
TRAPTrap: 'NAFLD = harmless' — NASH progresses to cirrhosis + HCC.
TOPIC PACK — PEDIATRICS
10 items·2 pods
1Congenital heart diseases, classification of CHD, VSD, ASD and PDA
CLINCHCHD: acyanotic (VSD = most common, ASD, PDA — left-to-right shunt, ↑pulmonary flow) vs cyanotic (TOF, TGA, tricuspid atresia). VSD: holosystolic murmur at left lower sternal border, LVH. ASD: fixed split S2. PDA: continuous machine murmur, bounding pulses.
TRAPTrap: 'VSD = cyanotic' — VSD is ACYANOTIC (left-to-right); cyanosis comes with reversal/right-to-left.
2Cyanotic heart disease, tetralogy of fallot, transposition of great vessel and important table
CLINCHCyanotic CHD: Tetralogy of Fallot (VSD + PS + overriding aorta + RVH — boot-shaped heart, squatting, tet spells → knee-chest, propranolol), TGA (transposition — parallel circuits, needs PGE/prostaglandin + surgery).
TRAPTrap: 'TOF = prostaglandin' — TOF needs PGE only for duct-dependent circulations; TGA is the duct-dependent one.
3Coarctation of aorta
CLINCHCoarctation of aorta: HTN in upper limbs, weak femoral pulses, rib notching, Turner syndrome association, treat surgically/balloon.
TRAPTrap: 'coarctation = equal pulses' — femoral pulses are WEAK/delayed vs brachial.
4Intussusception, intussusception versus volvulus, Hirschsprung disease and immunodeficiency disorders
DANGERIntussusception: 6-18 months, colicky pain + 'currant jelly' stool + sausage mass, ultrasound, air enema reduction. Volvulus: bilious vomiting, 'bird's beak', malrotation — surgical emergency. Hirschsprung: aganglionosis (rectum), failure to pass meconium, contrast shows transition zone, biopsy = gold, pull-through.
TRAPTrap: 'Hirschsprung = treat constipation' — it's surgical; biopsy confirms absence of ganglion cells.
5Wiskott Aldrich syndrome, meningitis in detail with CSF interpretation and croup versus epiglottitis
CLINCHWiskott-Aldrich: X-linked, thrombocytopenia + eczema + infection (immune deficiency). Meningitis: viral (lymphocytes, normal glucose) vs bacterial (neutrophils, low glucose, high protein). Croup: parainfluenza, barking cough, inspiratory stridor, dexamethasone/racemic epinephrine; epiglottitis: H. influenzae B, drooling, tripod, thumb sign, ENT emergency.
TRAPTrap: 'croup = intubate often' — croup is usually managed medically; epiglottitis is the airway emergency.
6Neonatology, APGAR score, neonatal jaundice, chromosomal abnormalities, Down syndrome, Patau syndrome and Edwards syndrome
CLINCHNeonatology: APGAR (appearance, pulse, grimace, activity, respiration — 0/1/2 each, at 1 and 5 min). Neonatal jaundice: physiologic (after 24h) vs pathologic (before 24h = hemolytic, ABO/Rh). Chromosomal: Down (trisomy 21, hypotonia, single palmar crease, AVSD), Patau (13, cleft, holoprosencephaly), Edwards (18, rocker-bottom feet, clenched fists).
TRAPTrap: 'jaundice <24h = physiologic' — jaundice BEFORE 24 hours is PATHOLOGIC until proven otherwise.
7Muscular dystrophy (Duchenne versus Becker dystrophy), infantile hypotonia (botulism versus myotonic dystrophy), and developmental milestone
CLINCHMuscular dystrophy: Duchenne (X-linked, dystrophin absent, Gower sign, calf pseudohypertrophy, cardiomyopathy) vs Becker (milder, dystrophin reduced). Infantile hypotonia: botulism (honey, descending weakness, constipation) vs myotonic dystrophy (trinucleotide repeat, myotonia). Developmental milestones: smile 2m, sit 6m, walk 12m, talk 18m — 'STAWP'.
TRAPTrap: 'Duchenne = Becker same severity' — Duchenne loses ambulation ~12y; Becker stays walking into adulthood.
8Febrile seizure, types, erythema infectiosum, measles and rubella
CLINCHFebrile seizure: 6 months-5 years, simple (<15 min, generalized once) vs complex (longer, focal, recurrent); no routine workup needed. Erythema infectiosum: fifth disease, 'slapped cheek', parvovirus B19. Measles: cough + coryza + conjunctivitis + Koplik spots, morbilliform rash. Rubella: mild, postauricular nodes, congenital syndrome (deafness, cataracts, PDA).
TRAPTrap: 'febrile seizure = start anticonvulsants' — simple febrile seizures need NO prophylaxis; reassure.
9Overview of diarrhea, acute versus chronic diarrhea and IMNCI classification with management
DANGERDiarrhea: acute (<2 weeks — viral usually rotavirus/norovirus, ORS) vs chronic (>2 weeks — malabsorption, IBD). IMNCI: Integrated Management of Neonatal & Childhood Illness — classify, treat, refer. Dehydration signs: sunken eyes, skin turgor, dry mucosa, lethargy.
TRAPTrap: 'antibiotics for diarrhea' — most acute diarrhea is viral; antibiotics only for dysentery/typhoid/cholera.
10Pneumonia, respiratory rates by ages, IMNCI classification of pneumonia and EPI vaccination schedule
CLINCHPneumonia: fever + cough + tachypnea, chest indrawing = severe, antibiotics (amoxicillin first). Respiratory rates by age (thresholds): <2 months >60, 2-12 months >50, 1-5 years >40. EPI: BCG at birth, OPV, DPT, measles 9 months, etc.
TRAPTrap: 'pneumonia = give antitussives' — antitussives are contraindicated in children with pneumonia; antibiotics + oxygen.
TOPIC PACK — BIOCHEMISTRY
9 items·2 pods
1Classification of vitamins and vitamin a (retinol), and vitamin d (calcitriol)
CLINCHVitamins: A (retinol — vision, night blindness; retinoic acid), D (calcitriol — calcium absorption; deficiency rickets/osteomalacia), E (tocopherol — antioxidant, hemolysis), K (phylloquinone — clotting factors II, VII, IX, X + protein C/S; warfarin blocks it).
TRAPTrap: 'vitamin D active form = D3 in diet' — active form is 1,25-(OH)2-D3 (calcitriol) made in kidney.
2Vitamin e, vitamin k, vitamin b function and deficiency
ACRONYMVitamin K: fat-soluble, deficiency → bleeding (FII, VII, IX, X), newborns get IM vitamin K. B vitamins: B1 (thiamine — beriberi, Wernicke), B3 (niacin — pellagra: dermatitis, diarrhea, dementia), B6 (pyridoxine — neurotransmitter synthesis, isoniazid neuropathy).
TRAPTrap: 'pellagra = B2' — pellagra is B3 (niacin) deficiency; B2 gives cheilosis/angular stomatitis.
3Vitamin B2, vitamin B3, vitamin B6 (cofactor and deficiency)
CLINCHB2 riboflavin: cheilosis, glossitis, corneal vascularization. B3 niacin: pellagra (3 Ds), flushing (nicotinic acid), tryptophan precursor. B6 pyridoxine: cofactor for amino acid metabolism, homocysteine, heme synthesis.
TRAPTrap: 'niacin = only lipid drug' — it also treats pellagra; its flushing is prostaglandin-mediated.
4Vitamin C (ascorbic acid), malnutrition (kawashiorkor versus marasmus), catecholamines synthesis (clinical condition)
CLINCHVitamin C: ascorbic acid — collagen synthesis, scurvy (bleeding gums, poor wound healing), enhances iron absorption. Malnutrition: kwashiorkor (protein deficiency with edema, fatty liver, 'flaky paint' rash) vs marasmus (calorie deficiency, wasting, no edema). Catecholamines: tyrosine → DOPA → dopamine → norepinephrine → epinephrine; pheochromocytoma → hypertension.
TRAPTrap: 'kwashiorkor = symmetric wasting' — kwashiorkor has EDEMA + fatty liver; marasmus is severe wasting.
5Maple syrup urine disease and disorder of galactose metabolism
STORYMSUD: maple syrup urine disease, branched-chain amino acids (leucine, isoleucine, valine) — deficiency of BCKD, ketoacidosis, sweet urine. Galactosemia: galactose-1-phosphate uridyl transferase deficiency, cataracts, liver failure, treat by removing galactose/lactose.
TRAPTrap: 'galactosemia = lactose tolerance' — it's an intolerance: galactose accumulates and damages.
6Glycogen metabolism and glycogen storage diseases
CLINCHGlycogen: storage of glucose in liver (maintains blood glucose) and muscle (local energy). Glycogen storage diseases: von Gierke (G6Pase — severe hypoglycemia, hepatomegaly), Pompe (acid maltase — cardiomegaly, infantile), McArdle (muscle phosphorylase — exercise intolerance, myoglobinuria), Cori (debrancher — milder).
TRAPTrap: 'von Gierke = muscle problem' — von Gierke is LIVER; McArdle is muscle.
7Lipoprotein, aminoacid, aminoacid derivatives and rate limiting enzyme
ACRONYMLipoproteins: chylomicrons (dietary TAG), VLDL (endogenous TAG), LDL (cholesterol to tissues — 'bad'), HDL (reverse transport — 'good'). Amino acids: 20 common, essential ones (PVT TIM HALL — Phe, Val, Thr, Trp, Ile, Met, His, Arg*, Leu, Lys). Rate-limiting enzymes: HMG-CoA reductase (cholesterol synthesis — statin target), glycogen phosphorylase (glycogenolysis), PEPCK (gluconeogenesis).
TRAPTrap: 'LDL = good cholesterol' — LDL delivers cholesterol to tissues (atherogenic); HDL is protective.
8Collagen and its types, and osteogenesis imperfecta
CLINCHCollagen: types I (bone, tendon — most abundant), II (cartilage), III (reticular, skin, early wound), IV (basement membrane). Osteogenesis imperfecta: type I collagen defect, blue sclera, multiple fractures, hearing loss.
TRAPTrap: 'OI = type II collagen' — OI is type I; type II mutation = achondrogenesis.
9Urea cycle, hyperammonemia and lysosomal storage diseases
CLINCHUrea cycle: ammonia → carbamoyl phosphate → citrulline → argininosuccinate → arginine → urea; defects → hyperammonemia. Hyperammonemia: vomiting, lethargy, encephalopathy — treat: protein restriction, sodium benzoate/phenylbutyrate, dialysis. Lysosomal storage: Gaucher (glucocerebrosidase — hepatosplenomegaly, Gaucher cells, bone crises), Niemann-Pick (sphingomyelinase — cherry red spot), Tay-Sachs (hexosaminidase A — cherry red spot, neuro, Ashkenazi).
TRAPTrap: 'urea cycle defect = treat with high protein' — protein is RESTRICTED + ammonia scavengers given.
TOPIC PACK — RESPIRATORY
9 items·2 pods
1Lungs volumes, lung capacity, hemoglobin modification and O2-HB dissociation curve
CLINCHLung volumes: tidal, IRV, ERV, RV; capacities: IC (TV+IRV), FRC (ERV+RV), VC (TV+IRV+ERV), TLC (all). Hemoglobin modifications: oxy-, deoxy-, carboxy- (CO, cherry red, high affinity), met- (iron Fe3+, cyanosis). O2-Hb curve: right shift (↑temp, ↑2,3-BPG, ↑H+ — more O2 release) vs left (↓temp, CO, fetal).
TRAPTrap: 'left shift = release more O2' — LEFT shift means Hb binds O2 tighter (LESS release); right shift releases.
2Ventilation, perfusion, VQ ratio and transport of gases in blood
CLINCHVentilation: air in/out; perfusion: blood flow; V/Q ratio: normal ~0.8. VQ mismatch: shunt (V/Q 0 — pneumonia), dead space (V/Q ∞ — PE). O2 transport: mostly on Hb (97%) + dissolved (3%); CO2: bicarbonate (70%) + carbamino + dissolved.
TRAPTrap: 'hypoxemia in PE = respond to 100% O2' — PE is a dead-space problem; the shunt effect won't fully correct with O2.
3Obstructive lung disease, bronchial asthma, management of asthma and anti inflammatory
DANGERObstructive: asthma, COPD, bronchiectasis — FEV1/FVC ↓. Asthma: variable airflow obstruction, wheeze, bronchial hyperreactivity; treat: SABA (salbutamol) for acute + ICS (budesonide) for control; leukotriene antagonists; severe → systemic steroids.
TRAPTrap: 'asthma = give beta-blockers' — beta-blockers precipitate bronchospasm; asthma needs beta-AGONISTS.
4COPD, chronic bronchitis versus emphysema, bronchiectasis, Kartagener syndrome, pneumoconiosis (silicosis, asbestosis, coal worker lungs)
CLINCHCOPD: chronic bronchitis (blue bloater — cough, cyanosis, cor pulmonale) vs emphysema (pink puffer — dyspnea, barrel chest, ↓DLCO), treated with bronchodilators + smoking cessation. Bronchiectasis: permanent dilation, chronic cough + purulent sputum, CF. Kartagener: situs inversus + sinusitis + bronchiectasis (dynein defect). Pneumoconiosis: silicosis (sAND — upper lobe fibrosis), asbestosis (lower lobe, mesothelioma risk, calcified plaques), coal worker (CWP).
TRAPTrap: 'silicosis = lower lobes' — silicosis is UPPER lobe; asbestosis is LOWER.
5Pleural effusion, transudative versus exudative effusion with management, pneumothorax, tension pneumothorax in detail and type I versus type 2 respiratory failure
DANGERPleural effusion: transudate (protein <3, LDH <2/3 serum — HF, cirrhosis) vs exudate (protein >3, LDH >2/3 — infection, malignancy); Light's criteria. Pneumothorax: spontaneous (tall young male, blebs) vs tension (mediastinal shift, tracheal deviation — needle decompression, chest tube). Respiratory failure: type 1 (hypoxemia, PaO2<60 — pneumonia, PE) vs type 2 (hypercapnia, PaCO2>50 — COPD, obesity hypoventilation).
TRAPTrap: 'tension pneumothorax = wait for CXR' — clinical diagnosis, immediate decompression, don't wait for imaging.
6Sarcoidosis, Lofgren syndrome, pulmonary HTN with management and sleep apnea in detail
CLINCHSarcoidosis: non-caseating granulomas, bilateral hilar lymphadenopathy, ↑ACE, erythema nodosum, Löfgren syndrome (fever, uveitis, erythema nodosum + hilar nodes — good prognosis). Pulmonary HTN: dyspnea, right heart strain, treat underlying; prostacyclin. Sleep apnea: OSA (obstructive — snoring, obesity, daytime sleepiness; CPAP is first-line).
TRAPTrap: 'OSA = sleep study contraindicated in severe' — polysomnography IS the diagnosis; CPAP is the first-line treatment.
7Lung cancer in detail, Pancoast tumour, mesothelioma and management of cough (anti-tussive versus expectorant)
DANGERLung cancer: SCC (central, cavitation, PTHrP → hypercalcemia, smoker), adenocarcinoma (peripheral, non-smoker), small cell (central, paraneoplastic, chemotherapy), large cell. Pancoast: apex tumor, Horner + shoulder pain + brachial plexus. Mesothelioma: asbestos, pleural thickening, poor survival. Cough: antitussive (opioid — dextromethorphan, codeine) vs expectorant (guaifenesin).
TRAPTrap: 'small cell = surgery' — small cell is treated with chemo/radiotherapy; surgery has no role.
8Development of lung with clinical relationship, conducting versus respiratory zone and minute versus alveolar ventilation
CLINCHLung development: embryonic → pseudoglandular → canalicular (surfactant starts ~24w) → saccular → alveolar (36w-8y); premature = surfactant deficiency → RDS, treated with steroids (prenatal) + surfactant. Conducting vs respiratory zones: conducting = no gas exchange (trachea to terminal bronchioles); respiratory = exchange (respiratory bronchioles to alveoli). Ventilation: minute (TV×RR), alveolar (dead space subtracted).
TRAPTrap: 'surfactant = in conducting zone' — surfactant is in ALVEOLI (respiratory zone), made by type II pneumocytes.
9Lungs relations, relation of pulmonary artery to bronchus, lung volumes, lung capacities, and loading versus unloading of O2
ACRONYMLung relations: right main bronchus = shorter, wider, more vertical — aspiration site; pulmonary artery: right = anterior to bronchus ('RALS'), left = superior/posterior. Volumes/capacities recap. Loading vs unloading: O2 binding/loading at lungs (high PO2), unloading at tissues (low PO2, right shift).
TRAPTrap: 'left PA = anterior' — RALS: RIGHT pulmonary artery is Anterior; LEFT is superior to the Left main bronchus.
TOPIC PACK — INFECTIOUS DISEASES
3 items·1 pod
1Pneumonia, causes, types, CURB-65, investigation and management
CLINCHPneumonia: CAP (S. pneumoniae most common; atypicals: mycoplasma, legionella, chlamydia), HAP. CURB-65 (confusion, urea >7, RR ≥30, BP low, age ≥65) decides inpatient vs outpatient. Treat: amoxicillin, macrolide, respiratory fluoroquinolone (levofloxacin).
TRAPTrap: 'legionella = normal urine' — legionella has urinary antigen test; mycoplasma has cold agglutinins.
2Tuberculosis, causative agent and anti-tubercular therapy
CLINCHTB: Mycobacterium tuberculosis, airborne, apical cavities, granulomas with caseation, Ghon complex; diagnose: sputum AFB, GeneXpert, culture; treat: RIPE — rifampicin, isoniazid, pyrazinamide, ethambutol (2 months intensive + 4 months continuation); DOTS. BCG vaccine.
TRAPTrap: 'TB = treat ethambutol-eye only' — ethambutol causes optic neuropathy (red-green); isoniazid causes peripheral neuropathy (give B6).
3TORCH infection and sexually transmitted diseases
CLINCHTORCH: toxoplasma, other (syphilis, varicella, parvovirus), rubella, CMV, herpes — congenital infections: microcephaly, cataracts, deafness, rash. STDs: gonorrhea (Gram-negative diplococci, purulent), chlamydia (silent, PID, infertility), syphilis (primary chancre, secondary rash, tertiary gumma/aortitis, neurosyphilis), HIV (CD4, opportunistic infections).
TRAPTrap: 'TORCH = all mothers symptomatic' — most are asymptomatic in mother but devastating to fetus.
TOPIC PACK — NERVOUS SYSTEM
15 items·3 pods
1Migraine headache, cluster headache, tension headache, subarachnoid hemorrhage and epidural hematoma versus subdural hematoma
CLINCHHeadache types: migraine (unilateral, throbbing, photophobia, aura, treat triptans), cluster (unilateral orbital pain, male, alcohol trigger, treat oxygen/sumatriptan), tension (bilateral band-like). SAH: thunderclap, neck stiffness, CT. Epidural (lucid interval, lentiform, MMA tear) vs subdural (chronic, elderly, bridging veins, crescent).
TRAPTrap: 'subdural = lucid interval' — lucid interval is EPIDURAL; subdural is gradual especially in elderly.
2Multiple sclerosis, internuclear ophthalmoplegia Guillain Barre syndrome and Parkinson diseases
DANGERMS: young female, optic neuritis, INO, Uthoff, oligoclonal bands, MRI demyelination — treat steroids (acute) + disease-modifying. GBS: ascending weakness, areflexia, post-infection, albuminocytologic dissociation — treat plasmapheresis/IVIG. Parkinson: bradykinesia + resting tremor + rigidity, Lewy bodies — levodopa.
TRAPTrap: 'GBS = steroids' — GBS is treated with IVIG/plasmapheresis, NOT steroids (worsens).
3Anti epileptic drugs, status epilepticus with management and aphasia with types in details
CLINCHAntiepileptics: phenytoin (Na channel, gingival hyperplasia, nystagmus), carbamazepine (Na, SIADH, teratogenic), valproate (multiple, hepatotoxic, teratogenic), levetiracetam (well-tolerated), ethosuximide (absence). Status epilepticus: >5 min or recurrent — lorazepam first, then phenytoin/levetiracetam. Aphasia: Broca (expressive, non-fluent, area 44/45) vs Wernicke (receptive, fluent nonsense, area 22).
TRAPTrap: 'phenytoin = absence seizures' — absence = ethosuximide/valproate, NOT phenytoin.
4Parkinson disease drug, Huntington disease and seizure versus epilepsy in detail
CLINCHParkinson drugs: levodopa (most effective, motor complications), dopamine agonists (pramipexole, ropinirole — young patients), MAO-B (selegiline), COMT (entacapone), anticholinergics (tremor). Huntington: CAG repeat (autosomal dominant), chorea, caudate atrophy, early dementia — tetrabenazine. Seizure vs epilepsy: seizure = single event, epilepsy = recurrent unprovoked ≥2.
TRAPTrap: 'early Parkinson = levodopa first' — young patients often start dopamine agonists to delay levodopa motor complications.
5Alzheimer's disease, vascular dementia, frontotemporal dementia, Lewy body dementia and normal pressure hydrocephalus
CLINCHDementias: Alzheimer (most common, amyloid plaques + neurofibrillary tangles, early memory loss), vascular (stepwise decline, stroke history), frontotemporal (personality change, Pick bodies), Lewy body (parkinsonism + hallucinations, fluctuating), NPH (triad: gait, incontinence, dementia — treat by shunt).
TRAPTrap: 'treat Alzheimer with dopamine' — Alzheimer uses cholinesterase inhibitors (donepezil) + memantine.
6Stroke with types, management, MCA, ACA, PCA and PICA block (lateral medullary syndrome)
DANGERStroke: ischemic (thrombotic vs embolic — AF) vs hemorrhagic (HTN). Acute: CT first (bleed vs no bleed), thrombolysis within 4.5h (tPA) if no bleed. Vessel territories: MCA (face/arm > leg, aphasia), ACA (leg > arm), PCA (vision), PICA (lateral medullary — Wallenberg: Horner + ataxia + loss of pain/temp face ipsilateral, body contralateral).
TRAPTrap: 'thrombolyze every stroke' — hemorrhagic stroke is an absolute contraindication; CT first.
7Spinal cord disease, facial nerve lesion UMN versus LMN, BPPV, vestibular neuritis versus acute labyrinthitis
CLINCHSpinal cord: anterior cord syndrome (bilateral motor + pain/temp loss, preserved DCML), Brown-Séquard (hemisection), central cord (older, hyperextension). Facial nerve: UMN (upper face spared) vs LMN (whole face). BPPV: brief positional vertigo — Epley. Vestibular neuritis (sudden severe, hearing OK) vs labyrinthitis (hearing affected).
TRAPTrap: 'UMN facial = whole face paralysis' — UMN spares the forehead (bilateral cortical innervation).
8Myasthenia gravis versus leng, CJD, brain tumours and sleep physiology with EEG wave form
DANGERMyasthenia gravis: anti-AChR, fatigable weakness, ptosis, diplopia — pyridostigmine, thymectomy; crisis → plasmapheresis/IVIG, avoid aminoglycosides. CJD: prion, rapid dementia + myoclonus, spongiform, EEG periodic sharp waves. Brain tumors: glioblastoma (most common malignant, butterfly), meningioma (benign, dural), medulloblastoma (children, vermis), metastasis (most common overall). Sleep physiology: REM (dreaming, atonia, theta/beta), NREM 1-3 (slow waves, growth hormone).
TRAPTrap: 'myasthenia = prednisone alone in crisis' — crisis is IVIG/plasmapheresis; steroids can transiently worsen.
9Neural development, neural tube defect (spina bifida occulta, meningocele and meningomyelocele)
CLINCHNeural tube defects: spina bifida occulta (hidden, tuft of hair) → meningocele (meninges only) → meningomyelocele (meninges + cord, most severe); prevention = folic acid pre-conception.
TRAPTrap: 'folic acid helps after conception' — it must be started BEFORE conception to prevent NTDs.
10Anencephaly versus holoprosencephaly, Chiari malformation I versus II and syringomyelia
CLINCHAnencephaly: absence of forebrain, incompatible with life. Holoprosencephaly: forebrain fails to divide (cyclops, midline defects). Chiari I (cerebellar tonsils herniate, headache with cough) vs II (Arnold-Chiari with myelomeningocele). Syringomyelia: central cavity, cape-like pain/temp loss, dissociated sensory loss.
TRAPTrap: 'syringomyelia = vibration loss' — it's PAIN/TEMP (spinothalamic crossing) with preserved DCML — dissociated sensory loss.
11Regional specifications of brain, neuron with parts, myelin sheath and Wallerian degeneration
CLINCHRegional brain: frontal (executive, Broca), parietal (somatosensory, Gerstmann), temporal (memory, hearing, Wernicke), occipital (vision), cerebellum (coordination). Neuron: dendrites (in), axon (out), myelin (oligodendrocytes CNS, Schwann PNS). Wallerian degeneration: distal axon degenerates after injury, proximal survives.
TRAPTrap: 'Schwann cells = CNS myelin' — Schwann for PNS; oligodendrocytes for CNS.
12Sensory receptors in detail and sleep physiology
CLINCHSensory receptors: mechanoreceptors (touch — Meissner, pressure — Pacinian), nociceptors (pain), thermoreceptors (temp), photoreceptors (light), chemoreceptors. Sleep physiology: circadian rhythm, melatonin from pineal, EEG stages (alpha awake, theta drowsy, delta deep, beta REM/active).
TRAPTrap: 'Pacinian = light touch' — Pacinian is DEEP pressure/vibration; Meissner is fine touch.
13Hypothalamus, important area of hypothalamus, thalamus and important nuclei
ACRONYMHypothalamus: thermoregulation, hunger, thirst, circadian, pituitary control (releasing/inhibiting). Important nuclei: supraoptic (ADH), paraventricular (oxytocin), lateral (hunger), ventromedial (satiety). Thalamus: sensory relay, lateral geniculate (vision), medial geniculate (hearing), ventral posterolateral (body sensation).
TRAPTrap: 'oxytocin = supraoptic' — oxytocin is PARAVENTRICULAR; ADH is supraoptic (remember 'SOADH'... SOUP).
14Stroke with types, vessel involved, blood supply of brain and PICA versus AICA
DANGERStroke types: ischemic (85%) vs hemorrhagic (15%). Vessels: MCA (most common), ACA, PCA, basilar (locked-in), PICA vs AICA (AICA = lateral pons with hearing loss). Know each territory's deficit. PICA = lateral medullary (Wallenberg).
TRAPTrap: 'basilar occlusion = mild' — basilar occlusion is catastrophic: locked-in syndrome or death.
15MCA stroke, ACA, PCA, ASA, PICA, basilar artery, AICA and PCA stroke
CLINCHTerritory strokes: MCA (face/arm, aphasia if dominant), ACA (leg), PCA (vision), ASA (anterior spinal artery - bilateral below level), PICA (lateral medullary), AICA (lateral pons), basilar (locked-in). Clinical: one territory, one deficit pattern — the examiner tests this.
TRAPTrap: 'PCA = motor' — PCA is vision (occipital); motor comes from ACA/MCA.
TOPIC PACK — GENERAL PATHOLOGY
4 items·1 pod
1Cell adaptation, hypertrophy, hyperplasia, atrophy and dysplasia and hypoplasia
CLINCHCell adaptation: hypertrophy (size ↑), hyperplasia (number ↑ — can be physiologic), atrophy (shrink), metaplasia (change — Barrett, smoking), dysplasia (precancerous disordered growth), hypoplasia (incomplete development).
TRAPTrap: 'hypertrophy vs hyperplasia same' — hypertrophy = bigger cells, hyperplasia = more cells; cardiac muscle can only hypertrophy.
2Cell injury, reversible versus irreversible cell injury and necrosis with types
CLINCHCell injury: reversible (swelling, fatty change) vs irreversible (membrane rupture, nuclear changes → necrosis). Necrosis types: coagulative (most — infarct, kidney/heart), liquefactive (brain, abscess), caseous (TB), fat (pancreas, breast), fibrinoid (vessel walls, immune).
TRAPTrap: 'brain infarct = coagulative' — brain is LIQUEFACTIVE (membranes lack structural proteins).
3Apoptosis, inflammatory with mediators, acute versus chronic inflammation and granuloma formation
CLINCHApoptosis: programmed, single cells, no inflammation (caspases, Bcl-2 family). Inflammation: acute (neutrophils, exudate — vascular changes, margination, emigration) vs chronic (lymphocytes, macrophages, fibrosis). Granuloma: organized chronic inflammation (TB, sarcoid, fungal).
TRAPTrap: 'chronic inflammation = neutrophils' — chronic is macrophages/lymphocytes; acute is neutrophils.
4Neoplasia, routes of metastasis
CLINCHNeoplasia: benign (encapsulated, well-differentiated, no mets) vs malignant (invasive, poorly differentiated, mets). Carcinoma (epithelial) vs sarcoma (mesenchymal). Metastasis routes: lymphatics (carcinoma) vs blood (sarcoma), and specific sites (liver from GIT, bone from prostate/breast/lung, brain from lung).
TRAPTrap: 'malignant = always fast' — some (thyroid papillary) grow slowly but can still metastasize.
TOPIC PACK — IMMUNOLOGY
3 items·1 pod
1Overview, innate versus adaptive immunity, humoral versus cell mediated immunity, antibodies with types, HSR I, HSR II, HSR III and HSR IV
CLINCHInnate vs adaptive: innate (fast, nonspecific — barriers, complement, macrophages, neutrophils; pattern recognition TLRs) vs adaptive (slow first time, specific, memory — B and T cells). Humoral (B cells → antibodies) vs cell-mediated (T cells — CD4 helper, CD8 cytotoxic). Antibodies: IgA (mucosa), IgE (allergy, parasites), IgG (most abundant, crosses placenta), IgM (first, pentamer), IgD (B cell receptor). HSR I (immediate, IgE, anaphylaxis — epinephrine), II (IgG/IgM cell-based — hemolysis), III (immune complexes — SLE, serum sickness), IV (delayed, T cell — TB, contact dermatitis).
TRAPTrap: 'IgE = most abundant' — IgG is; IgE is lowest but mediates anaphylaxis.
2Types of graft, transplant rejection, important autoantibodies and therapeutic antibodies
CLINCHGrafts: autograft (self), isograft (identical twin), allograft (same species), xenograft (different species). Rejection: hyperacute (preformed antibodies, minutes, vascular), acute (cellular/antibody-mediated, days-weeks, treat immunosuppression), chronic (fibrosis, late). Autoantibodies: anti-dsDNA (SLE), anti-CCP (RA), anti-TPO (Hashimoto), anti-AChR (myasthenia). Therapeutic antibodies: rituximab (anti-CD20), trastuzumab (HER2), infliximab (anti-TNF).
TRAPTrap: 'hyperacute rejection = cellular' — hyperacute is HUMORAL preformed antibodies, immediate, irreversible.
3Vaccination with types in detail, HLA, MHC I versus MHC II
DANGERVaccination: live-attenuated (MMR, varicella — contraindicated in pregnancy/immunocompromised) vs inactivated (IPV, hepatitis A, flu inactivated). HLA: human leukocyte antigen, MHC class I (all nucleated cells, CD8) vs class II (antigen-presenting cells — dendritic, macrophage, B cell; CD4). Important: MHC I presents endogenous (viral), MHC II presents exogenous.
TRAPTrap: 'live vaccine in pregnancy = OK' — live vaccines are CONTRAINDICATED in pregnancy and immunocompromised.
TOPIC PACK — OPHTHALMOLOGY
5 items·1 pod
1Chalazion versus stye, ectropion versus entropy, myopia, hyperopia, astigmatism and presbycusis
CLINCHChalazion (painless meibomian granuloma) vs stye (painful eyelash follicle infection). Ectropion (eyelid turns OUT — exposure) vs entropion (turns IN — lashes rub cornea). Refractive: myopia (near clear, eyeball long, negative lens/concave), hyperopia (far clear... actually near blurry, positive lens/convex), astigmatism (irregular cornea), presbyopia (age-related accommodation loss).
TRAPTrap: 'myopia = convex lens' — myopia needs CONCAVE (minus) lenses; hyperopia needs convex.
2Structure of human eye, drainage of aqueous humour, glaucoma (closed angle versus open angle glaucoma)
DANGEREye structure: cornea → anterior chamber → lens → vitreous → retina. Aqueous humour: ciliary body → posterior chamber → pupil → anterior chamber → trabecular meshwork → canal of Schlemm. Glaucoma: open-angle (chronic, silent, tunnel vision, treat drops — prostaglandin analogues, beta-blockers) vs closed-angle (acute, painful, fixed mid-dilated pupil, nausea — emergency: acetazolamide, pilocarpine, laser iridotomy).
TRAPTrap: 'acute glaucoma = painless' — angle-closure is PAINFUL + red eye + N+V; open-angle is the silent thief.
3Clinical case
CLINCHClinical case: web-based interactive — apply ophthalmology to vignettes (acutely painful red eye, sudden visual loss, gradual loss, diplopia).
TRAPTrap: 'treat symptom without measuring vision/pressure' — always check VA, IOP, pupils.
4Trachoma, CRAO versus CRVO, cataract, endophthalmitis, dacryocystitis and pterygium
DANGERTrachoma: chlamydia, leading infectious cause of blindness, trichiasis — surgery + azithromycin. CRAO (painless sudden monocular blindness, cherry-red spot, urgent — CRAO = '8-second eye') vs CRVO (painless with retinal hemorrhages, 'blood and thunder'). Cataract: lens opacity, gradual, surgery. Endophthalmitis: post-op infection, urgent intravitreal antibiotics. Dacryocystitis: lacrimal sac infection, watering + discharge. Pterygium: conjunctival growth onto cornea, UV exposure.
TRAPTrap: 'CRAO wait and see' — CRAO is an emergency (aim <90 min); ocular massage, acetazolamide, hyperbaric.
5Conjunctivitis in detail, corneal ulcer, diabetic retinopathy and grading of hypertensive retinopathy with important topics
CLINCHConjunctivitis: viral (watery, preauricular node), bacterial (purulent), allergic (itchy, bilateral). Corneal ulcer: painful red eye + photophobia + epithelial defect — urgent. Diabetic retinopathy: background (microaneurysms, dot-blot hemorrhages), proliferative (neovascularization, vitreous hemorrhage — panretinal photocoagulation), maculopathy. Hypertensive retinopathy grading: arteriovenous nicking, cotton wool spots, flame hemorrhages, papilledema (grade IV = malignant HTN).
TRAPTrap: 'diabetic retinopathy screening starts when symptomatic' — annual screening from diagnosis; damage precedes symptoms.
TOPIC PACK — MICROBIOLOGY, DERMATOLOGY, PSYCHIATRY, FORENSIC, AND COMMUNITY MEDICINE
7 items·1 pod
8Autonomic nervous system
CLINCHAutonomic nervous system: sympathetic (fight/flight — noradrenaline, α1 vasoconstriction, β1 heart, β2 bronchodilation) vs parasympathetic (rest/digest — acetylcholine, muscarinic).
TRAPTrap: 'β2 = heart' — β2 is bronchial/vascular SMOOTH MUSCLE (dilation); β1 is cardiac.
9Autonomic nervous system - lecture 2
CLINCHAutonomic pharmacology: sympathetic agonists (epinephrine), antagonists (beta-blockers); parasympathetic agonists (pilocarpine, neostigmine), antagonists (atropine — mydriasis, dry mouth, tachycardia, urinary retention).
TRAPTrap: 'atropine = constrict pupil' — atropine DILATES (mydriasis); pilocarpine constricts.
10Autonomic nervous system - lecture 3
CLINCHAutonomic lecture 3: receptor distribution and clinical correlations — know where each receptor lives, what each drug does there.
TRAPTrap: 'memorizing receptors without the clinical scenario' — binds receptor to a case.
11Forensic medicine lecture 2
CLINCHForensic lecture 2: legal medicine — consent, medical certificates, dying declaration, medical negligence, expert witness.
TRAPTrap: 'forensic = only autopsy' — legal medicine (consent, negligence, certificates) is exam-weighted.
12Forensic medicine - lecture 1
CLINCHForensic lecture 1: identification, postmortem changes, autopsies, wounds, poisoning — basic medicolegal postmortem.
TRAPTrap: 'postmortem lividity = antemortem bruise' — lividity is a postmortem settling, not trauma.
13Community medicine in details
CLINCHCommunity medicine in detail: epidemiology (incidence vs prevalence, sensitivity/specificity), prevention levels, immunization schedules, health indicators, screening programs, occupational health, biostatistics interpretation.
TRAPTrap: 'prevalence = new cases' — prevalence is ALL existing cases; incidence is NEW cases in a period.
14Fractures with applied clinical
CLINCHFractures with applied clinical: classification (open/closed, comminuted, greenstick in children), principles (reduction, immobilization, rehabilitation), complications (compartment syndrome, fat embolism, AVN, non-union).
TRAPTrap: 'greenstick = adult' — greenstick is a CHILDREN's fracture (incomplete, flexible bone).
TOPIC PACK — REVISION SESSIONS
15 items·3 pods
1Revision of applied anatomy
CLINCHRevision of applied anatomy: re-run the tracts, foramina, and nerve palsies — the exam loves cranial nerves and crossing levels.
TRAPTrap: 'skipping revision because you did it once' — the forgetting curve is real; this is the anti-decay pass.
2Revision of applied biochemistry
CLINCHRevision of applied biochemistry: vitamins, glycogen storage, urea cycle, collagen — the memorization-heavy section that rewards repeated recall.
TRAPTrap: 'biochem = low yield' — NRE asks the classic memorized facts; they are high-yield when known cold.
3Revision of internal medicine endo
CLINCHRevision of internal medicine endo: thyroid, adrenal, pituitary, DM — the systems with the sharpest discriminators.
TRAPTrap: 'endo = only DM' — thyroid/adrenal/pituitary disorders are equally tested.
4Revision of internal medicine cvs
CLINCHRevision of internal medicine cvs: murmurs, heart failure, MI management, arrhythmias, antiarrhythmics — know the drug classes cold.
TRAPTrap: 'CVS = mostly ECG' — clinical vignettes (murmurs, HF drugs, MI) matter as much as ECG.
5Revision of internal medicine renal
CLINCHRevision of internal medicine renal: AKI classification, nephrotic vs nephritic, tubular syndromes, diuretics.
TRAPTrap: 'nephrotic/nephritic same' — proteinuria/edema = nephrotic; hematuria/HTN/RBC casts = nephritic.
6Revision of internal medicine MS
CLINCHRevision of internal medicine MS: arthritis (RA/OA/gout), seronegative spondyloarthropathies, vasculitides, CTDs.
TRAPTrap: 'gout = RA' — gout is crystal arthritis (urate), RA is autoimmune (anti-CCP).
7Revision of internal medicine hema
CLINCHRevision of internal medicine hema: anemias by MCV, leukemias/lymphomas, bleeding disorders, transfusion reactions.
TRAPTrap: 'anemia workup = Hb only' — start with MCV to split micro/normo/macro.
8Revision of internal medicine GIT
CLINCHRevision of internal medicine GIT: PUD, IBD, pancreatitis, liver disease, GI malignancies — the complication patterns.
TRAPTrap: 'Crohn vs UC' — skip lesions + fistulas = Crohn; continuous + bloody = UC.
9Revision of ENT and ophthalmology
DANGERRevision of ENT and ophthalmology: hearing loss types, vertigo causes, red eye emergencies, vision loss patterns.
TRAPTrap: 'red eye = conjunctivitis until proven' — acute glaucoma/keratitis/uveitis are the dangerous red eyes.
10Revision of gynae and obs
CLINCHRevision of gynae and obs: pregnancy HTN, PPH, menstrual disorders, contraception, gynecological cancers.
TRAPTrap: 'antenatal HTN = all preeclampsia' — chronic vs gestational vs preeclampsia differ by timing and proteinuria.
11Revision of nervous system
CLINCHRevision of nervous system: stroke territories, seizures/epilepsy, parkinsonism, dementia, headache red flags, myasthenia.
TRAPTrap: 'all weakness = stroke' — myasthenia (fatigable), GBS (ascending, areflexic), and MS (disseminated) mimic stroke.
12Revision of IM respiratory system
DANGERRevision of IM respiratory: asthma/COPD, pneumonia (CURB-65), PE, pleural effusion (Light), respiratory failure types, lung cancer.
TRAPTrap: 'type 2 respiratory failure = high O2 always' — in COPD, controlled O2; type 2 = hypercapnia needs NIV/ventilation.
13Revision of embryology and reproductive system
CLINCHRevision of embryology and reproductive system: development periods, teratogens, congenital anomalies, reproductive physiology.
TRAPTrap: 'teratogen window = any time' — organogenesis (weeks 3-8) is the critical teratogenic window.
14Revision of pediatrics
CLINCHRevision of pediatrics: CHD (cyanotic/acyanotic), neonatal jaundice, milestones, IMNCI, EPI, febrile seizures, dehydration.
TRAPTrap: 'milestones = exact months' — exam gives ranges (sitting 6-8m, walking 12-15m); know the safe windows.
15Quick revision - ENT and ophthalmology
CLINCHQuick revision — ENT and ophthalmology: the rapid pass before the exam — hearing, vertigo, red eye, trauma, vision loss.
TRAPTrap: 'quick revision = skip details' — the quick pass is for ALL the discriminators, just faster.
Fact source: NRE Core Master + Medical Lectures Video Title Backbone — every line verbatim, anchored to its source (line numbers for facts, pack numbers for topics).
Tricks & traps: original scaffolding — hooks, not source material. Built Sep 22, 2026.