USMLE Step 1: Integrated Vignettes

Must-know, high-yield review

• Editorial: Kaplan Test Prep
• Año: 2019
• ISBN:
  9781506254234
• Categoría: Study Aids
• Categoría: Study Guides

Kaplan Medical's USMLE Step 1 Integrated Vignettes provides must-know, high-yield facts for the Step 1 exam. A "question bank in book format, " this portable tool will help you bridge the gap between preclinical coursework and Qbank usage. The focus is on integrated cases and differential diagnoses, along with practical clinical correlations.
High-Yield Review

• Checklist of pathological processes within each organ system
• Clinical vignettes with high-yield explanations of conditions
• Ten representative diseases detailing morphologic features and differential diagnoses
• Physiology and pharmacology correlations for every disease
• Practice questions for self-assessment

1

CHAPTER 1

Hematopoietic and Lymphoreticular System

Checklist of Processes Within This System

Developmental Disorders

Congenital thymic cyst

Thymic hypoplasia

Accessory spleen

Fanconi anemia

Diamond-Blackfan anemia

Infectious Diseases

Splenic hydatidosis

Infectious mononucleosis

Cat-scratch disease

Malaria

CMV

Inflammatory Diseases

Acquired multilocular thymic cyst

Graft-versus-host disease

Autoimmune Diseases

Autoimmune hemolytic anemia

Immune thrombocytopenic purpura

Trauma

Penetrating splenic injury

Blunt splenic trauma

System-Specific Diseases

Reactive changes in WBCs: leukocytosis and leukopenia

Morphologic changes in RBCs

Shape changes: elliptocytes, spherocytes, target cells, acanthocytes, echinocytes, schistocytes, bite cells, teardrop cells, sickle cells

Red cell inclusions on microscopy: basophilic stipples, Howell-Jolly bodies, Pappenheimer bodies, ring sideroblasts, Heinz bodies

Platelet disorders: thrombocytopenia

Anemias: micro-, macro-, normocytic

Extramedullary hematopoiesis

Lymphadenopathy

Splenomegaly

Neoplasia

Lymphoid neoplasms: mature B cell neoplasms, peripheral T-cell and natural killer neoplasms, Hodgkin lymphoma, B and T lymphoblastic lymphoma/leukemia

Myeloid neoplasms: acute myelogenous leukemia, myelodysplastic syndromes

Myeloproliferative neoplasms: chronic myelogenous leukemia, polycythemia vera, essential thrombocythemia, myelofibrosis with myeloid metaplasia

Multiple myeloma

Localized extracutaneous mast cell neoplasms

Splenic lymphangiomas and hemangiomas

Thymomas

Posttransplant lymphoproliferative disorder

2

Representative Diseases

What follows are clinical vignettes for 10 select diseases within this organ system. First, read the vignette and try to identify the condition. Then, move on to read integrated information on each disease.

Vignette 1

A full-term baby girl is born to a 23-year-old G1P0 mother who did not seek prenatal care. The newborn turns blue shortly after birth; she also has a cleft palate. Within a few hours of birth, she develops muscle spasms. Lab evaluation reveals a low CD3 count and low ionized calcium.

Diagnosis? __________________

Vignette 2

A 54-year-old college professor notices that his face appears red and swollen. Physical examination is also notable for distended veins in his neck. Chest x-ray shows a well-circumscribed anterior mediastinal mass with no evidence of local invasion, lung mass, or lymphadenopathy.

Diagnosis? __________________

Vignette 3

An 8-year-old boy presents to the pediatrician with yellow eyes, pale skin, and dark urine. His mother states that he began having upper respiratory symptoms 2 days ago. She also states that her brother has similar episodes when he gets a cold. CBC is notable for normocytic anemia, elevated bilirubin, and negative fluorescent spot test. Peripheral blood smear reveals Heinz bodies and bite cells.

Diagnosis? __________________

Vignette 4

A father takes his 6-year-old son to the pediatrician because of several dark itchy lesions below the waistband of his shorts and under his socks. He is otherwise healthy. The father states the boy appears to scratch his legs more on hot days. Physical examination reveals many hyperpigmented patches that are most prominent around the waist and ankles.

Diagnosis? __________________

3

Vignette 5

A 16-year-old boy presents with a high fever for several days. He also reveals that he has lost 10 pounds in the last 2 weeks. Physical examination reveals bilateral nontender lymphadenopathy. Imaging of the chest demonstrates a bulky anterior mediastinal mass.

Diagnosis? __________________

Vignette 6

A 45-year-old woman presents to the ED with a spontaneous nosebleed. She reports 1 week of a fever that has not responded to acetaminophen. She denies cough, shortness of breath, abdominal pain, dysuria, and rash. Physical examination is notable for active bleeding from the nares bilaterally and numerous pinpoint red papules on her lower extremities. Lab evaluation reveals elevated white blood cell count, low hemoglobin/hematocrit, and low platelets.

Diagnosis? __________________

Vignette 7

A 68-year-old man presents for an annual physical examination. He reports mild fatigue for several months but attributes this to “just getting older.” Lab evaluation reveals microcytic anemia, undetectable ferritin, and thrombocytopenia.

Diagnosis? __________________

Vignette 8

A 26-year-old woman presents to her primary care physician complaining of 1 year of heavy menses. On physical examination there are several red pinpoint macules on the buccal mucosa and there are ecchymoses on the extremities. Platelet count is 18,000/μL.

Diagnosis? __________________

Vignette 9

A 50-year-old male smoker presents to the ED with a severe headache and dizziness. CBC is significant for hemoglobin 18.5 g/dL and urinalysis is positive for blood. Abdominal imaging reveals a renal mass.

Diagnosis? __________________

Vignette 10

A 25-year-old man is playing with a new rescue cat he recently brought home. A few days later he develops a swollen red lesion on his left hand. Two weeks later he develops painful swelling in his left axilla and a fever.

Diagnosis? __________________

4

Vignette 1

A full-term baby girl is born to a 23-year-old G1P0 mother who did not seek prenatal care. The newborn turns blue shortly after birth; she also has a cleft palate. Within a few hours of birth, she develops muscle spasms. Lab evaluation reveals a low CD3 count and low ionized calcium.

Pathogenesis. 22q11.2 deletion syndrome is also known as DiGeorge syndrome and velocardiofacial syndrome. It is caused by a microdeletion on chromosome 22 on the long (‘q’) arm at the 11.2 locus. This deletion leads to abnormal fetal development of 3rd and 4th pharyngeal pouches, which are involved with the development of the thymus and parathyroid glands. Most patients are heterozygotes; the disorder is usually sporadic but can be familial with autosomal dominant inheritance. It is one of the most common syndromes with multiple anomalies.

Clinical Presentation. The syndrome phenotype is highly variable. Children with the syndrome typically present with some combination of cardiac malformation, thymic hypoplasia with immunodeficiency, and hypocalcemia due to hypoparathyroidism. It is the most common syndrome associated with cleft palate. Cardiac malform...