Approach to workup of cholangitis, chronic cholecystitis, Gallstone Ileus, Cholangiocarcinoma including Klatskin tumor, Carcinoma of GB and Pancreas At the end some house-cleaning on iatrogenic complications of gallstone disease after ERCP and other procedures are discussed (including bile duct injury and bile leak); For SOD refer to previous episode on cholecystitis management and complications of cholecystectomy.

Question-based Review of Cholecystitis workup and management followed by addressing the complications of cholecystectomy.

Both Pathophysiology and Clinical Aspects of gallstone disorders are discussed followed by important hints on differential diagnosis of gallstone disease from one another and from their complications, most specifically from cholecystitis and cholangitis.

Question-based review of workup for hepatic neoplasms.

Questions & cases regarding diagnostic workup and management for PBC, PSC, Alcoholic & Non-Alcoholic Fatty Liver Disease (steatosis, steatohepatitis), and Vascular Hepatopathy

High-Yield Question-based review & cases of conditions associated with abnormal iron & copper metabolism

Question-based review of differential diagnosis in chronic HBV vs HCV infection.

High-Yield question-based review of cases in hepatitis B pathophysiology.

Questions-based review of risk factors, differential diagnosis and management of acute viral hepatitis A, D , E . Included co-infection, Superinfection, diagnostic workup (screening and confirmatory) and management options with discussion of post-exposure prophylaxis for HAV infection.

High-Yield cases & Question-based Review of 2 important complications of Cirrhosis (SOAP format). (For other complications look at hepatic encephalopathy in Acute liver failure and for Peritonitis to the previous episode)

Following the SOAP approach, we review Subjective, Objective, Assessment & Plan for Ascites & Peritonitis. Exudative versus Transudative classification compared to new SAAG-based classification are discussed for differential diagnosis. Values of SAAG in relation to Protein content, Cell count, LDH and Glucose and pH values as well as major risk factors are discussed to differentiate primary (spontaneous) versus 2ndary bacterial peritonitis. and management guidelines provided. Needs some mathematical understanding of SAAG formula and couple exceptions to the rules (as discussed).

Following our SOAP format we have a question-based discussion of Subjective (epidemiology, risk factors, patients complaints), Objective (PhEx findings, lab assessment results), Assessment (of possible etiologic differential diagnosis) and Plan for management of cirrhosis.

Question-based review of Acute liver failure, staging of hepatic encephalopathy (per clinical & EEG criteria), management of ALF with understanding of the severity criteria, Stage-based management of hepatic encephalopathy, Indications & Eligibility requirement for Liver transplantation, and a brief discussion on acetaminophen toxicity at the end.

After an important question-based assessment of structural versus functional components of hepatocyte markers, we discuss high-yield cases of Hepatitic, cholestatic and mixed-pattern LFT abnormalities. This is prerequisite to entire liver & hepatobiliary system discussions.

Case-Based Review of Respiratory Failure Management. Please make sure you understand the indications & contraindications for supplemental versus active (invasive & non-invasive) modes of ventilatory support before going through cases.

Indications and contra-indications for common methods of non-invasive ventilation are discussed in quick question-based format with cases as a preparation to the next major episode (i.e. discussion of management options in different types & severities of respiratory failure)

Question-based and quick review of important subject of patients in need of invasive active airway intervention (as opposed to those who benefit from non-invasive intervention or those who just need supplemental oxygenation without a need for active airway). We discuss endotracheal intubation (including crash intubation, RSI, Elective ETI) and we discuss alternatives including crycothyrotomy versus long-term surgical airway indication (i.e. Tracheostomy).

Basics of approach to patient in need of respiratory support and airway management. Question-Based Discussion of "Hierarchical Ladder of Respiratory Support", patient stratification based on indications & contraindications to different modalities of respiratory support. This provides initial management considerations and framework for proper algorithmic approach when addressing the airway management in trauma or respiratory failure patients.

Brief but high-yield question-based approach to differential diagnosis in hypercapnic failure. Analyzing the differentials and management options based on the formula of Alveolar Minute Ventilation: Alveolar Minute Ventilation = Respiratory Rate x (Tidal Volume - Dead Space Volume) VA = RR x (Vt-Vd) DDxing of hypercapnia includes low RR (e.g. opiate use), Low Vt (e.g restrictive lung disease) or high Vd (COPD).

Discussion of initial workup, classification and differential diagnosis of hypoxia & Hypoxemic respiratory failure. 1- Please make sure you have the formulas ready in front of you (including PA-O2 formula, O2 delivery, O2 content and Fick's Formulas among others). 2- If you need to pause and repeat do so before moving on (it can save lives ....!)

Differential Diagnosis of metabolic Alkalosis and the overall approach to metabolic alkalosis with cases and step-up scenarios including Saline-Responsive and Unresponsive Types based on Urine Chloride; Brief yet high-yield review of compensation and how to make sense of compensation formulas in acid-base disorders. Also discussed: Syndrome of apparent mineralocorticoid excess (SAME, Including Liddle Syndrome), Gitelman & Bartter;

RTAs

Question-based discussion of the proper framework approach metabolic acidosis, serum versus urinary anion gap, categories of high-anion-gap versus normal anion-gap acidosis and are discussed.

Question-based Discussion of risk factors, workup and management of rhabdomyolysis.

Question-based Review on Differential Diagnosis of Hypercalcemia (Pseudohypercalcemia, PTH-dependent vs PTH-independent Hypercalcemia) and Hypocalcemia; Vitamin D abnormalities, Abnormalities of Phosphate. Also discussed: Workup & Management of Humoral Hypercalcemia of Malignancy, Familial Hypocalciuric Hypercalcemia, Pseudohypoparathyroidism, True Hypoparathyroidism, Primary, 2ndary and tertiary hyperparathyroidism, Medications Side-Effects causing abnormalities of Ca & P.

Question-based review on differential diagnosis and algorithmic approach to workup & management of hypokalemia followed by a discussion of magnesium abnormalities.

Question-based Approach to differential diagnosis and hierarchical management in hyperkalemia.

Differential Diagnosis of pseudohypernatremia, Hypovolemic, Euvolemic and Hypervolemic Hypernatremia as well as Differential Diagnosis of pseudohyponatremia vs true hyponatremia is discussed.

A High-yield fully question-based review of childhood vasculitides

The important question is when to suspect vasculitis based on clinical presentation? We discuss differentials and workup (with emphasis on ANCA positivity or negativity or markers of Glomerular involvement) as well as management options and complications (including Mono-neuritis multiplex) for most common classes of vasculitides including Medium-size & Small - vessel Vasculitides including Polyarteritis Nodosa (including updated 3/10 Diagnostic criteria of American College of Rheumatology), Buerger's Disease (Thromboangiitis Oblisterans) Wegener's Granulomatosis, Microscopic Polyangiitis, Churg-Strauss.

We discuss the general differential diagnosis & framework of workup for large-vessel, medium-vessel & small-vessel vasculitides, general treatment guidelines and prognostication for vasculitides; Then we focus (in this episode) on large-vessel vasculitides (Giant-cell & Takayasu arthritis)

Differential diagnosis and workup of primary versus 2ndary amyloidosis ( including indication for abdominal fat pad versus single-organ biopsy, required workup for plasma-cell dyscrasia in Biopsy-confirmed amyloidosis, Required organ-function tests in Amyloidosis ) as well as management for primary (AL) versus 2ndary (AA) amyloidosis.

In this episode we first finish the discussion of the remaining subtypes of SNSAPs (namely Reactive ARthritis & Entropathic arthropathies / IBD-related Arthropathies) while discussing the important differential diagnosis for each category. We finish with a high-yield subject of approach framework and step-up management options by comparing and contrasting proper treatment recommendations for each stage of management based on the most recent guidelines.

High-yield question-based review of clinical points regarding subjective, objective, assessment and plan (SOAP) approach to seronegatives; We first discuss the general points relevant to this category of inflammatory arthritides then we initiate an in-depth discussion of each individual disorder while remaining as brief as possible but not missing the high-yield points. This episode covers Ankylosing spondylitis and Psoriatic Arthritis.

General approach to preoperative functional assessment using American Society of Anesthesiology Functional & Preoperative Status guidelines , Metabolic Equivalent, Cardiac Risk Assessment of MACE based on risk of patient versus the risks of surgical procedures, Utilizing Revised Cardiac Risk Index in the approach.

We discuss surgical site infection (SSI), Wound disruption and dehiscence, Superficial & deep Fascial Disruption, as well as wound evisceration and ventral hernia.

Differential Diagnosis & Management Approach of common childhood seizures including some genetic & hereditary subtypes , like benign rollandic, juvenile myoclonic and childhood absence seizure; we finish with a DDxing of childhood hemiplegia. Please make sure you have reviewed our episode on febrile seizure before this one.

While the initial step in managing sleep disorders involves ruling out 2ndary causes, in most cases (including the primary sleep disorders) the first intervention includes sleep hygiene and behavioral modifications; it is crucial to know when CBT-Insomnia is the recommended initial intervention and when pharmacotherapy is indicated and what type of medications are used for each subtype of primary sleep disorders. We finish with discussing choice of pharmacotherapy in different sleep disorders while discussing first line treatment for cases of special population and comorbidities with sleep disorder (including pregnant patient, those with dementia, etc).

Differential Diagnosis of 7 major DSM-V categories of sleep disorders including Insomnia, Parasomnias (REM-related & Non-REM type), Sleep related breathing disorders, Sleep related movement disorders, Central Hypersomnia (including Narcolepsy), and Circadian-Rhythm Disorders / Sleep-Wake Phase disorders. High-Yield hints are provided for differentiating these conditions after a framework of initial medical & organic categories are ruled out.

We discuss definition of febrile seizure with required criteria, followed by discussing simple versus complex types as well as their workup and management with an in-depth discussion of how to address family concerns; we then finish with the important differential diagnosis approach between febrile seizure and meningitis.

An overview of prenatal screening during pregnancy; we discuss first prenatal visit, overall algorithm of prenatal assessment, types of infectious and non-infectious labs as well as general versus risk-specific panels of prenatal screening as a high-yield framework of prenatal care and follow up.

Question-Based Review of Reproductive Embryology (only clinically relevant points)

High-yield differential diagnosis of heart sounds abnormalities including changes in the intensity and splitting of S1, S2 as well as etiologies of S3 & S4 gallops with strategies to identify them. 

Flashcard - style questions on precordial palpation and assessment of carotid and jugular (venous) pulse with discussion of important differential diagnosis of several conditions including venous wave abnormalities

Systematic questions on Radiologic anatomy and trauma assessment of cardiac box, auscultation for valvular heart disease, and ECG-correlations of coronary arteries

High-yield questions on Chronic Granulomatous Disease, Chédiak-Higashi Syndrome, Leukocyte Adhesion Deficiency and Complement disorders associated with primary immunodeficiencies. 

In-depth discussion of pathophysiologic mechanisms and examples of four major classes of hypersensitivity reactions; relevant for USMLE step 1 and USMLE step 2,3 

Review of different classes of immunologic agents such as monoclonal antibodies, Interleukin receptor agonists & antagonists and other agents with their clinical indications and side effect profile; prerequisite to this episode is the review of foundational basic science of immunosuppressive agents 

Following the format of conceptual / clinical understanding, Pathogenesis , Epidemiology & Risk Factors, followed by Clinical Findings, Diagnostic Workup and an important discussion of pharmacotherapy in gout and preventive measures.  

High Yield discussion for vaccination guidelines among patients with primary immunodeficiencies; 

We discuss the following disorders of adaptive immune system resulting in primary immunodeficiency: B-cell disorders: Agammaglobulinemia (including Bruton's), Selective IG deficiency (including selective IgA deficiency), Common Variable Immunodeficiency T-cell Disorders: DiGeroge, IL-12 receptor pathway disorders (Mendelian Susceptibility to Mycobacterial Infection), Chronic Mucocutaneous Candidiasis Combined B & T cell disorders: Severe combined immunodeficiency (SCID), Autosomal- Dominant Hyper-IgE Syndrome, Wiskott-Aldrich, Ataxia-Telangiectasia, Hyper-IgM syndrome

These (HLH & ALPS) are the major syndromes of innate and adaptive immune dysregulation respectively resulting in primary immunodeficiency. For the discussion of complement system dysregulation refer to episode on innate immune deficiencies of innate immune system. Also compare HLH with MAS (macrophage activation syndrome) discussed in pharmacotherapy of Juvenile Rheumatoid Arthritis

Very clinically-oriented episode on important clues on subjective & Objective assessment of a patient to help clinically identify different types of primary immunodeficinecies; 

Basic science foundational knowledge required for understanding the pathogenesis of different primary immunodeficiency syndromes as well as closely-related mechanisms interrupted by immunosuppressive agents; 

Question-based review on Classification & Pathogenesis of Drug and Hypersensitivity Reactions

An important discussion of pseudogout (chondrocalcinosis), its subtypes, methods to diagnose and differentiate it from gout and other polyarticular or mono-articular joint disorders with similar presentations. 

High-yield question-based discussion on Risk Factors, Pathogenesis, Epidemiology, Diagnostic Workup and Management options of osteoporosis (relevant for USMLE steps 1, 2, 3)

A question-based review of Paget's disease, Osteopetrosis and Avascular Necrosis relevant for USMLE step 1 & 2

Discussion of overlap syndrome named MCTD followed by primary versus secondary forms of Raynaud's phenomenon / disease are discussed

Both subtypes (limited cutaneous including CREST syndrome and diffuse cutaneous) of systemic sclerosis are discussed with workup and management point followed by discussion of important complications (including scleroderma renal crisis)

In this episode we compare and contrast clinical features and management for different subtypes of JIA with mainly focusing on Oligoarticular, RF-positive Polyarticular, RF-negative Polyarticular and Systemic-onset subtypes of JIA; Make sure you have a good understanding of rheumatoid arthritis and specially its pharmacotherapy prior to this episode. 

Comparing & Contrasting the Pathogenesis,  Clinical features, Patterns of joint involvement, Diagnostic workup and Management options for rheumatoid arthritis versus osteoarthritis (AKA Degenerative Joint Disease); Next episode will provide a more in depth-discussion of rehumatoid arthritis management with focus on pharmacotherapy with DMARDs. 

Lots of zebras that can be relevant for basic science and to some extend for clinical science assessment; the focus will be on molecular pathogenesis and diagnostic features of Achondroplasia, Osteogenesis Imperfecta, Dysostoses and Fibrous Dysplasia including the polyostotic variant McCune Albright; A high-yield discussion regarding differential diagnosis off Cafe-au-Lait macules is offered at the end. (Note: Some resources consider Klippel-Feil syndrome also as part of skeletal dysplasias, however we covered it together with disorders of cervical spine in a different episode)

A high-yield discussion of clinical assessment and management options for kyphosis, scoliosis, and causes of low back pain in children (including muscle strain, spondylolysis, Discitis and Herniated Disk)

We continue our rapid-fire question-based review of pediatric orthopedics with focusing on Brachial plexus injuries (Mainly Erb & Klumpke's palsy) with some high-yield review of over-all upper extremity innervation; We follow that with Nursemaid's elbow and Anterior shoulder dislocation; We then begin our discussion of spine disorders with cervical spine: Torticollis, Atlantoaxial instability, and Klippel-Feil syndrome; We follow the rest of spine disorders (including Kiphosis & scoliosis) as well as important Differential Diagnoses of Low-Back pain among children in the next episode. 

Bullet-point review questions on miscellaneous lower extremity disorders of childhood associated with pain

Systematic Question-based review of pigeon-towing, clubfoot (Talipes equinovarus), Internal tibial torsion, medial femoral torsion (anteversion), Bowed-legs (genu varum), Knock-knee (genu valgum) and Progressive tibia vara (Blount disease)

A high-yield question-based review of clinical points related to childhood hypocalcemia with approach to its differential diagnoses and evaluation of pseudohypocalcemia, followed by a discussion of Rickets and Osteomalacia. 

In this episode we will continue our discussion of the limp in children (as a very high-yield subject for almost all healthcare providers) with mainly focusing on some of the non-febrile limp or non-antalgic gait; in the intro, we emphasize that no single finding can be used to categorize the type of limp or gait and an overall clinical picture should be taken into consideration; 

After a brief discussion of different categories of limp in children with emphasis of differentials of antalgic, non-antalgic, traumatic and febrile limp, we focus on septic arthritis, osteomyelitis, transient synovitis and couple other conditions such as acute rheumatic fever & arthropathy of lyme disease as the possible underlying causes of limp in a febrile child. 

High-yield comparison of different pathogenesis, clinical features, diagnostic evaluation, and management options for Ewing sarcoma versus Osteosarcoma, with a brief discussion of chondrosarcoma; High-yield for USMLE step 1 and 2. 

High-yield review of conditions such as giant-cell tumor, brown tumor and bone cysts (Unicameral versus Aneurysmal) in both pediatric and adult orthopedics

A question-based review of Osteoma, Osteochondroma, Enchondroma, after a high-Yield review of classification and approach to differential diagnosis

Types of Fractures (Open vs Closed, Complete vs Incomplete, Physeal / Salter-Harris , Epiphyseal , Metaphyseal, Diaphyseal); Clavicular Fx, Supracondylar Humeral Fx, Forearm Fx, Toddler Fx including spiral tibial Fx, Fractures indicating non-accidental trauma / child abuse possibility

High-Yield Question-Based Review of Impulse control and disruptive behavior disorders with their age considerations Discussion of Differential Diagnosis of Oppositional Defiant Disorder, Conduct Disorder, Intermittent Explosive Disorder, Disruptive mood Dysregulation Disorder, Pyromania, Kleptomania

Discussion of DSM-V diagnostic criteria and the difference with DSM-IV conditions Important developmental features & assessment of developmental milestones A brief list of important Differential Diagnoses of Autism Spectrum Disorder Genetic disorders & Inborn Errors of Metabolism that can be the underlying etiology and their diagnostic assessment Detailed discussion and numerous examples on Early features of Autism, Symptoms among preschool children versus school-aged children Workup and Management of Autism Spectrum Disorder (For USMLE Steps 1, 2, 3)

A questioned-based review of hyperkinetic movement disorders of childhood with emphasis on Tics (primary and 2ndary) and Tourette syndrome as well as stereotypies (as important differential diagnosis of Autism Spectrum Disorder) including Rett Syndrome (X-linked Dominant developmental regression) followed by a brief discussion of important differentials of Chorea, Myoclonus and Dystonia Subjects are important for USMLE Steps 1,2, 3

An introduction to 6 major DSM-V categories of child & adolescent psychiatry A discussion of 4 major clinical complaints among children & adolescent with neurodevelopmental disorders A brief overview of Differential Diagnosis for child behavioral problems, poor school performance, speech problems and distractibility 

High-yield questions on common and compound-specific clinical manifestations of major 3 categories of abused inhalants Volatile hydrocarbons & Halogenated compounds, Nitrogen-based inhalants with important clinical & lab clues for diagnosis of each substance Several performance-enhancing drugs are reviewed with a final high-yield case discussion

A very high-yield discussion of receptor functions of NMDA agonists and antagonists (including short-term versus long-term blockade) Discussion and Differential Diagnosis of PCP intoxication Review of other Psychedelics: Psilocybin, LSD & Mescaline, Jimson Weed, etc (high-yield for USMLE steps 1,2,3)

Question-based review of Cannabis-use disorder and medical use of THC Amphetamine congeners (stimulant hallucinogenic congeners of amphetamine) 

General Assessment of Alcohol Use disorders Assessment of Acute Alcohol Intoxication Acute and Maintenance Treatments for Alcohol Dependence Mild, Moderate or Severe Syndromes of Alcohol Withdrawal Drugs Recommended versus Drugs Contraindicated during the management of Alcohol Withdrawal Based on Updated 2021 Guidelines

Clinical framework for conceptual understanding of different manifestations of AUD (Alcohol Use Disorders) Hierarchical categories of Alcohol-Related Disorders & Alcohol Use disorders Epidemiologic significance of Alcohol-Related Disorders (including Global Burden of the Diseases) Demographic versus Acquired Risk Factors of AUD & Alcohol-related disorders Clinical features of Alcohol Intoxication Clinical Features of Alcohol Dependence Long-term organ involvement & Complications with Alcohol Dependence

Functional Neuroanatomy and Receptor Actions of Ethanol Definition of standard drinks and comparing different alcoholic beverages Clinical relevance of Blood Alcohol Concentration 1st and 2nd stages of Ethanol Metabolism Disulfiram Reaction 

Amphetamines, Cocaine, Nicotine, Caffeine are discussed with their molecular neuroanatomy and neurotransmitter function General and specific clinical manifestations of each stimulant abuse, intoxication, dependence or withdrawal are discussed Important aspects of cardiac protection in cocaine abuse as well as medications for maintenance therapy in nicotine / smoking cessation are discussed. 

Schedules of Controlled Substances Discussion of clue to identifying patients with "Drug-seeking behaviors" Risk factors for each of the three major prescription drugs being misused Preventive Measure to be taken by doctors to reduce the risk & rate of prescription-drug misuse Discussion of clinical findings, workup and management of Benzodiazepine-Use Disorder (Intoxication & Withdrawal)

Diagnosis and Management of Opioid Intoxication Diagnosis and Management of Opioid Dependence (including maintenance psychopharmacotherapy) Diagnosis and Management of Opioid Abstinence (withdrawal) Syndrome

Receptor functions of opioid agonists, mixed agonist-antagonists, and opioid antagonists; Drug interactions and pharmacokinetics and metabolism of opioid medications The clinical uses and possible side effects and toxicity of different classes of opiate-active medications Drugs discussed include full agonists, codeine, tramadol, propoxyphene, buprenorphine, nalbuphine, butorphanol, nelmefene, naloxone, naltrexone

Discussion of important terminology (Tolerance, Dependence, Abstinence Syndrome) , Dopaminergic pathway of Reward & Addiction, General Screening, Assessment and Management Approach to Substance Intoxication (Acute versus Maintenance Strategies) and Withdrawal. 

Discussion of the most common eating disorder (Binge eating disorder) followed by certain eating & feeding disorders infancy and childhood based of DSM-V manual, for USMLE step 1 & 2. 

Question-based Review and Differentiating features of Anorexia & Bulimia Nervosa, based on DSM-V diagnostic manual, including a discussion of Refeeding Syndrome (for USMEL step 1 & Step 2) 

High Yield and fully question-based discussion of adjustment disorder based on DSM-V criteria followed by another high-yield differential clues to distinguish normal from complex grief and both conditions from depressive disorders. 

High yield and question-based discussion of truama & stress-related disorders based on DSM-V updated criteria;  A very important diagnostic framework to work with stress-related conditions is introduced followed by discussion of PTSD and Acute Stress Disorder; To be followed in the next episode with discussion of Adjustment disorder and normal versus complex bereavement. 

Question-based review of different psychotic disorders including points that are relevant for both step 1 and step 2 USMLE; covering conditions listed under psychotic disorders in DSM-V followed by an initial discussion of differential diagnosis & management options. 

Question-based initial (knowledge-acquisition) step for mood disorders,  one of the top 5 highest yield topics in the entire psychiatry & behavioral science exams. 

Discussion of DSM-V criteria for diagnosis of each anxiety disorder, Workup and Management of individual Anxiety disorders: Generalized Anxiety, Separation Anxiety Disorder, Selective Mutism, Phobias (social versus specific type), Panic Disorder and Hyperventilation Syndrome

The list of all anxiety disorders and their definition, pathophysiology, Imaging and Psychodynamic Defence Mechanisms Make sure you review this list prior to studying individual anxiety disorder as certain disorders are emphasized by USMLE but are not discussed in common review sources

Tips to prioritize learning & studying psychiatry, Review of the most high-yield subjects based on USMLE Content Outline, DSV-V changes, what are the general Test-Taking and Patient workup Skills in Psychiatry 

USMLE Content Outline Topic: Malabsorption Lab Workup A Question-based & High-yield Review of laboratory assessment in chronic diarrhea & malabsorption. 

USMLE Content Outline Topic: Malabsorption Syndromes A high-yield & Rapid Review of Common Intestinal Malabsorption Syndromes including Short bowel syndrome, Small Intestinal Bacterial Overgrowty, Protein-losing Enteropathies / Intestinal Lymphangiectasias,