USMLE Comprehensive Review – Lecture Pages 11-20

Vocabulary flashcards covering manic vs hypomanic criteria, bipolar disorders, carcinoid syndrome, cardiac conduction, meningitis pathogens, renin-aldosterone patterns in hypertension, thyroiditis types, Class I antiarrhythmics, cognitive testing domains, colonoscopy findings in various diseases, and key congenital TORCH infections.

Manic episode

A period of ≥1 week (or any duration if hospitalized) of abnormally elevated or irritable mood causing marked social/occupational impairment or needing hospitalization; psychotic features may be present.

Hypomanic episode

At least 4 consecutive days of elevated or irritable mood with observable change in functioning but without marked impairment, hospitalization, or psychosis.

Bipolar I disorder

Mood disorder characterized by at least one manic episode; major depressive episodes are common but not required for diagnosis.

Bipolar II disorder

Mood disorder defined by ≥1 hypomanic episode and ≥1 major depressive episode; no history of a manic episode.

Cyclothymic disorder

≥2 years of fluctuating mild hypomanic and depressive symptoms that never meet full criteria for hypomanic or major depressive episodes.

Psychotic features (bipolar)

Hallucinations or delusions occurring during a mood episode; their presence automatically classifies the episode as manic rather than hypomanic.

Carcinoid syndrome

Systemic symptoms due to serotonin-secreting neuroendocrine tumors, typically metastatic to liver.

Carcinoid flushing

Cutaneous vasodilation causing episodic redness and warmth (flushing and telangiectasias) of the skin in carcinoid syndrome.

Carcinoid diarrhea

Watery, cramping stools produced by excess serotonin increasing GI motility.

Carcinoid bronchospasm

Wheezing or dyspnea triggered by serotonin-induced bronchial smooth-muscle contraction (bronchospasm).

Carcinoid heart disease

Fibrous plaques on right-sided heart valves leading to tricuspid or pulmonic regurgitation.

5-HIAA test

24-hour urinary measurement of 5-hydroxyindoleacetic acid is used to confirm carcinoid syndrome. A CT/MRI of the abdominal pelvis is done to localize the tumor

Octreotide

Somatostatin analog used to control flushing and diarrhea in symptomatic carcinoid syndrome. The surgery is reserved for liver metastasis

Cardiac conduction velocity order

Mnemonic for Park At Venture Avenue: Purkinje, Atria, Ventricles, AV Node (fast → slow).

Streptococcus pneumoniae (meningitis)

Lancet-shaped gram-positive diplococcus; most common adult cause of bacterial meningitis.

Neisseria meningitidis

Gram-negative bean-shaped diplococcus causing outbreaks and second most common adult meningitis.

Staphylococcus aureus (meningitis)

Gram-positive cocci in clusters; often follows penetrating skull injury or neurosurgery.

Group B Streptococcus (agalactiae)

Gram-positive cocci in chains; important neonatal meningitis pathogen.

Listeria monocytogenes

Motile gram-positive rod causing meningitis in neonates, elderly, and immunocompromised patients.

Escherichia coli (meningitis)

Gram-negative rod frequently responsible for neonatal meningitis.

Haemophilus influenzae type b

Gram-negative coccobacillus formerly common meningitis cause, now rare due to Hib vaccine.

Secondary hyperaldosteronism

Hypertension with high renin and high aldosterone, as in renovascular hypertension disease, Malignant hypertension, renin-secreting tumor, or diuretic use.

Primary hyperaldosteronism

Hypertension with low renin and high aldosterone, typically from an adrenal adenoma (Aldosterone producing tumor) or Bilateral Adrenal Hyperplasia.

Renovascular hypertension

Renin-driven hypertension secondary to renal artery stenosis; causes hypokalemia via aldosterone.

Malignant hypertension (renin)

Severe hypertension that increases renin output, leading to secondary hyperaldosteronism.

Renin-secreting tumor

Juxtaglomerular cell neoplasm producing excess renin, causing hypertension and hypokalemia.

Congenital adrenal hyperplasia (DOC)

Enzyme deficiency (11β- or 17α-hydroxylase) elevating deoxycorticosterone, causing mineralocorticoid excess with low renin and low aldosterone.

Cushing syndrome (mineralocorticoid)

Hypercortisolism that may mimic mineralocorticoid excess, producing hypertension and hypokalemia.

Exogenous mineralocorticoids

Synthetic hormones that mimic aldosterone, leading to increased sodium and water retention, and potassium excretion. Identifiable by low renin low aldosterone levels.

Subacute granulomatous (de Quervain) thyroiditis

Painful thyroid enlargement following viral illness with transient hyperthyroidism, elevated ESR/CRP, and low Radioiodine uptake, granulomatous histology with giant cells is seen. This type of thyroiditis resolves spontaneously.

Hashimoto thyroiditis

Autoimmune painless goiter with hypothyroidism, positive TPO antibodies, lymphoid infiltrate with well-developed germinal centers, and Hürthle cells (Eosinophilic epithelial cells). It is characterized by thyroid infiltration by lymphocytes, leading to gradual destruction of the thyroid gland.

Class IA antiarrhythmics

Quinidine, procainamide, disopyramide; intermediate sodium-channel block, prolong action potential.

Class IB antiarrhythmics

Lidocaine, mexiletine; weak sodium-channel block, shorten action potential duration.

Class IC antiarrhythmics

Flecainide, propafenone; strong sodium-channel block, no change in action-potential length.

Phase 0 depolarization

Initial rapid upstroke of the cardiac action potential mediated by sodium influx; slowed by Class I drugs.

Orientation test

Cognitive screen asking patient to state name, location, and date.

Comprehension test

Assessment of ability to follow multistep verbal commands.

Concentration test

Task such as reciting months backwards to evaluate attention span.

Short-term memory test

Recall of three unrelated words five minutes after presentation.

Long-term memory test

Providing details of significant past life events to assess remote memory.

Language test

Writing a complete sentence with proper grammar to evaluate expressive language.

Visuospatial test

Copying or drawing intersecting pentagons to assess spatial processing.

Executive function test

Drawing a clock to a requested time, checking planning and organization.

Colonic adenocarcinoma (gross)

Protuberant mass seen on colonoscopy; biopsy shows dysplastic mucosal cells with variable degree of gland formation.

Cytomegalovirus colitis

Multiple ulcers/erosions with biopsy showing large cells (Cytomegalic cells) containing intranuclear inclusion bodies.

Cryptosporidium colitis

Nonulcerative inflammation with basophilic clusters seen on the surface of intestinal mucosa; diagnosis confirmed by stool examination or biopsy. .

Entamoeba histolytica colitis

Numerous flask-shaped ulcers; biopsy reveals trophozoites with ingested RBCs.

Kaposi’s sarcoma (GI)

Reddish-violet flat Maculopapular lesion or Hemorrhagic nodules; spindle-shape tumor cells with small-vassel proliferation on biopsy.

Ulcerative colitis (colonoscopic)

Continuous erythematous friable granular mucosa with possible pseudopolyps. On biopsy, mucosal/submucosal inflammatory Infiltrate with crypt abscesses.

TORCH infections

Congenital infections acquired in utero causing characteristic neonatal syndromes (Toxoplasma, Others, Rubella, CMV, HSV).

Toxoplasma gondii (congenital)

Obligated intracellular protozoan causing triad of chorioretinitis, intracranial calcifications, and hydrocephalus.

Congenital rubella

SSRNA virus producing sensorineural deafness, cataracts, Heart defects (patent ductus), hepatosplenomegaly, and “blueberry-muffin” rash.

Congenital CMV

dsDNA virus causing sensorineural deafness, periventricular calcifications, jaundice, hepatosplenomegaly, and choriorretinitis.

Congenital HSV

Neonatal infection presenting with vesicular skin lesions or scarring at birth.

Congenital VZV

Varicella-zoster (dsDNA virus) infection leading to limb hypoplasia, cutaneous scars, cataracts, and chorioretinitis.

Congenital parvovirus B19

ssDNA virus infection in utero causing severe anemia and hydrops fetalis.

Congenital syphilis

Treponema pallidum infection producing “snuffles,” hepatomegaly, and skeletal deformities.