Podcasts about links boardvitals

Session 31 A 55-y/o heavy smoker is shown to have a peripheral, well-circumscribed mass with popcorn-like calcifications in the RUL. What is the lesion likely composed of? Dr. Karen Shackelford from BoardVitals joins us once again as we delve into another case to prepare you for your Step 1 or Level 1 exam. Save 15% off their QBank by using the coupon code BOARDROUNDS. BoardVitals has a powerful QBank with comprehensive explanation and rationales behind all of their questions. Get up-to-date board review questions. You can avail of their 3 or 6-month plan and ask a clinician. Ask one of the physicians behind all of the questions. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:48] Question of the Week: A 55-year-old male with a 40-year history of smoking who undergoes a low-dose chest CT for lung cancer screening. Imaging results show a peripherally located, well-circumscribed 2-cm mass in his right upper lobe. It has a popcorn-like calcification. Which of the following describes the characteristics of this mass? (A) is composed predominantly of fattened cartilage (B) is composed of poorly differentiated neuroendocrine cells (C) is composed of significant glandular components (D) is caused by keratin production and intracellular desmosomes (E) is formed by caseating granuloma around the causative organism [03:00] Thought Process Behind the Correct Answer The correct answer here is Answer choice E refers to TB and this doesn't sound like TB as there are popcorn lesions with TB. Answer choice A would sound more or less of a benign tumor. B sounds like a malignant small cell lung cancer. C would make you think of adenocarcinoma. [03:00] Thought Process Answer choice A would sound more or less of a benign tumor. B sounds like a malignant small cell lung cancer. C would make you think of adenocarcinoma. Answer choice E refers to TB and this doesn't sound like TB as there are popcorn lesions with TB. The correct answer here is A. A well-circumscribed lung tumor with predominantly fattened cartilage is a hamartoma. A trick that helped me remember this back in medical school is that “popcorn isn’t bad.” It's the most common benign tumor of the lung. It usually contains connective tissue, fat, and cartilage. It's classically associated with popcorn-like calcifications on imaging. They are relatively large, well-demarcated and they rarely impinge on surrounding structures. For the management of pulmonary hamartoma, it would be more beneficial not to undergo surgery. The approach to those tumors is individualized unless it's diagnosed as a stable nodule. Karen stresses the importance of not overdiagnosing people. Once you figure out it's not causing any problems, you just leave it there. [06:08] Understanding the Other Answer Choices The poorly differentiated neuroendocrine cells is a small cell lung cancer. It's a really aggressive malignancy that is most common in smokers. They usually have irregular margins and has a really poor prognosis largely because it tends to metastasize. Significant glandular components are characteristic of adenocarcinoma. It's the most subtype of lung cancer. It has both solid and ground blast components on imaging. It's a pretty heterogenous-looking tumor. It's usually peripherally located. Keratin production and intracellular desmosomes are characteristic of squamous cell carcinoma. It's a common form of non-small cell lung cancer. It originates from epithelial cells along the airways. They're usually centrally located, often associated with the larger bronchi. Caseating granuloma is characteristic of pulmonary tuberculosis around the causative organism. It usually looks like a focal cavitary lesion often in upper lobes. The patients usually have a risk factor like travel to an area where TB is endemic. Or there's exposure to infected individuals or incarceration. Links: BoardVitals (coupon code BOARDROUNDS)

Session 29 Which of these neurotransmitters is mostly likely causing this patient’s galactorrhea and secondary amenorrhea? Where is it coming from? Dr. Karen Shackelford from BoardVitals. When you're looking to prepare for your Step 1 or Level 1 board exams, check out how BoardVitals can help you. You can find all their amazing QBanks for Step1, Level 1, or even any of your SHELF exams. Use the coupon code BOARDROUNDS to save 15% off. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:37] Question of the Week A 34-year-old woman presents with amenorrhea for six months (secondary amenorrhea). Her menstrual cycles have been regular until this episode. She has, most of her life, a period every 28 days with a menstrual period that lasted three days. Today, on exam, a white nipple discharge is noted. A test for urine hCG is negative. Which of the following neurotransmitters suppresses the release of the hormone responsible for her condition? (A) Dopamine (B) Insulin (C) Serotonin (D) Somatostatin (E) Vasopressin [Related episode: Why Is This Menstruating Patient So Sick?] [02:50] Thought Process Behind the Correct Answer The correct answer here is A. If you think about the treatment for prolactinoma, where prolactin is released from the anterior pituitary, bromocriptine and cabergoline are used to shrink the prolactinoma. They're both dopamine agonists. The patient's symptoms are suggestive of prolactinoma. It's not totally obvious though as there wasn't headaches or visual field issues mentioned. Nevertheless, prolactinoma is the most common of all pituitary adenomas. It's also the most common cause of galactorrhea. The clinical features include amenorrhea, galactorrhea, and infertility. The prolactin normally stimulates the mammary glands to produce milk and inhibits the secretion of gonadotropin-releasing hormone, which results in amenorrhea and infertility. With large tumors, like the compression of the optic chiasm that results in bitemporal hemianopsia. Dopamine is normally used to suppress and release the prolactin. When you're not breastfeeding after birth, this becomes an issue. [05:15] Understanding the Incorrect Answers Insulin is produced by the pancreas and it's necessary for the uptake and utilization of glucose. Serotonin agonist is available in several classes, used as antidepressants. They're used to treat migraines, but not for prolactinoma. Additionally, some antipsychotic agents interfere with prolactin. Somatostatin is a hormone secreted by the pancreas that inhibits secretion of insulin and glucagon. It reduces the activity to digest the system. It's not receptive to dopamine and not related to galactorrhea. Vasopressin is an antidiuretic hormone and it's not affected by dopamine agonist. [06:22] Key Takeaways The key concept is that prolactinoma is probably the most common type of pituitary tumor and is the most common cause of galactorrhea. The symptoms occur because prolactin stimulates the mammary glands and suppresses GnRH, causing amenorrhea and infertility. The dopamine agonist suppresses prolactin secretion and shrinks the prolactinoma. Links: BoardVitals (coupon code BOARDROUNDS to save 15% off)

Session 27 A patient with a history of arrhythmia is found to have atrial amyloid deposition on autopsy. Do you know what peptide is associated with this finding? Dr. Karen Shackelford joins us for another round of interesting questions to help you ace your boards. If you haven’t yet, check out BoardVitals and use the promo code BOARDROUNDS to save 15% off. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [02:14] Question of the Week The autopsy of the patient with a history of arrhythmia revealed amyloid deposition in the atria but no other amyloid was found in the ventricles. Which of the following peptides is associated with amyloid deposition in the atria? And what is that peptide's function? (A) Calcitonin and reduction of blood calcium concentration (B) Prolactin and gastric emptying (C) Acetylcholine and positive chronotropy to sinoatrial node (D) Immunoglobulin and cell-mediated immune response (E) Atrial natriuretic peptide and vasodilation [Related episode: Cardiac Electrophysiology—What is it?] [03:15] Thought Process Behind the Correct Answer The correct answer is E. An amyloid is a group of diverse extracellular proteins in variable amino acid sequences and they have common physical properties. Amyloid deposition and the extracellular deposition of the fibrils are composed of the subunit of varied serum proteins that form beta-pleated sheet configurations that lead to the histologic changes seen in amyloidosis. Isolated amyloidosis is found only in a single organ such as this cardiac amyloidosis. Alpha-atrial natriuretic peptide is responsible for deposition in this isolated cardiac amyloidosis. This is what's responsible for amyloid deposition in part. The incidence appears to be maybe part of the normal process of aging. In one autopsy series, 86% of the patients between the age of 81 and 90 had isolated atrial amyloidosis. It may lead to heart failure. Although diuretics are commonly given to patients with heart failure due to cardiac amyloidosis, beta-blockers, calcium channel blockers, and ace inhibitors may be harmful. [05:55] Understanding the Wrong Answer Choices Calcitonin is associated with isolated amyloidosis of the thyroid. Prolactin is associated with lactation found in amyloidosis that is isolated to the pituitary gland. Acetylcholine is the negative chronotropic sinoatrial node in the right vagus nerve. The stimulation of the nerve decreases the firing of the SA nodes, increasing potassium and decreasing sodium and calcium movement to the cell. Finally, immunoglobulin amyloid deposition is widespread and it's the result of its light chain immunoglobulin deposition. The point of the question was that isolated amyloidosis can affect many particular organs. This is different from more widespread amyloidosis related to immunoglobulin in terms of ideology and distribution. [07:10] The Big Takeaway Amyloid is not just that atrial natriuretic factor but you have to ask yourself where is it is as you're reading this question. Is it in the parathyroid for prolactin or widespread for the immunoglobulin or is it in the atrium for the atrial natriuretic peptide? [08:11] BoardVitals Check out BoardVitals for their Step 1 and Level 1 QBanks. Use the promo code BOARDROUNDS to save 15% off. This can be used for your SHELF exam QBanks as well. Links: BoardVitals

Session 26 A 20-year-old menstruating adult is tachycardic, somnolent, and hypotensive with GI symptoms and macular rash. What sort of organism do you suspect? As always, we're joined by Dr. Karen Shackelford from BoardVitals. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:35] Question of the Week A 20-year-old female patient presents 5th day of her menstrual period complaining about abdominal pain, vomiting, watery diarrhea, and myalgia for 12 hours. On exam, her temperature is 103.13 F. Her blood pressure is 80/60 mm/Hg. And her heart rate is 135 beats per minute. She is ill-appearing, somewhat somnolent, has hyperemic 02:04 and a generalized erythematous macular rash that involves her palms and soles. Which of the following best describes the cause of her illness? (A) Gram-negative diplococci (B) Gram-negative obligate intracellular bacteria (C) Gram-positive facultative anaerobic cocci (D) Single positive stranded RNA virus [Related episode: Biology Grab Bag of Questions for the MCAT] [02:50] Thought Process Behind the Correct Answer The correct answer here is C. The patient has toxic shock syndrome. It didn't mention in the question but she had an indwelling tampon. Highly absorbent tampons are the biggest risk factor. But interestingly, half of the women who develop toxic shock syndrome during the menstrual period are not using tampons actually. Related to the menstrual period, however, a toxic shock is usually the result of infection by Staphylococcus aureus. It releases endotoxins. But also, 05:33 axis is superantigen. And that's what triggers the syndrome. It triggers the activation of T-lymphocyte and they release massive amounts of cytokine. The post-immune response is limited in patients with toxic shock. Studies show that people who end with toxic shock, they failed to develop an antibody against the bacteria that usually developed in up to 95% of the population in childhood. The criteria for diagnosis include fever, chills, hypotension, and dermatologic findings. Evident multi-system organ involvement is at least 3 body systems and that counts the skin. In this patient's case, she had her circulatory system. She had hyperemia of her mucus membranes. The maculopapular rash would eventually desquamate after 1-2 weeks. She had nausea, vomiting, diarrhea in the GI system. Her mental status was somnolent. Some people have seizures from somnolence or encephalopathy that the other organ involvement may include intrinsic renal failure or prerenal failure. Myalgias are also sometimes resolved in elevated serum creatinine phosphokinase. hepatic dysfunction is also not uncommon. [07:50] The Treatment If there's foreign body removal, the treatment of any surgical wounds is the rapid administration of appropriate antibiotics. This includes Vancomycin and Clindamycin with the Penicillin that has B-lactamase inhibitor. [08:10] Understanding the Wrong Answer Choices You would probably suspect meningococcal meningitis but then you would have thought they would have given you a clue about the stiff neck. Rocky Mountain spotted fever for answer choice B would also be a good thought. The USMLE Step 1 is going to give you clues to the most typical case. For instance, with Rocky Mountain spotted fever, they would probably mention that the patient was in an endemic area. But they wouldn't necessarily say he was bitten by a mosquito. Finally, Dengue fever is the diagnosis for answer choice D. Remember that they're not going to hand-feed you every single detail. It's not always going to be that easy. [11:00] BoardVitals Check out BoardVitals' USMLE Step 1 QBank or their COMLEX Level 1 QBank. They have 1-month, 3-month, and 6-month packages. Every time you purchase, a vaccine is donated. If you get the 3-month or 6-month package, they offer the Ask a Clinician feature where you can respond to a question. Then one of the physicians from BoardVitals will respond to you as well. Use the promo code BOARDROUNDS to save 15% off. Links: BoardVitals (promo code: BOARDROUNDS to save 15% off)

Session 24 We're joined by Dr. Karen Shackelford from BoardVitals as we talk about hepatitis and how antigens and antibodies appear and disappear during the course of infection. Please also check out Specialty Stories, a podcast dedicated to helping you figure out what specialty you want to practice. Listen to different physicians as I interview them about why they chose their specialty, what they like and don't like about it, and much more. Maximize your Step 1/Level 1 prep by checking out BoardVitals. Check out their 3 or 6-month plan where you get access to there over 1700-question QBank. Get detailed explanations and rationales for every question targeted to the Boards. Use the promo code BOARDROUNDS to save 15% off. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [02:20] Question of the Week A 45-year-old male presents a sudden onset of flu-like symptoms and yellowing eyes which he thought looks scary to him when he saw his reflection on the mirror. His past medical history reveals positive Hepatitis B infection and his lab's elevated ALT and AST levels. The consult suspects that he may not be superinfected with Hepatitis D. Hepatitis D virus can only propagate in the presence of Hepatitis B. The presence of which of the following components of Hepatitis B viral protein is necessary to allow Hepatitis D infection? (A) HpX (pX antigen) (B) Hepatitis B core antigen (HBcAg) (C) Hepatitis B surface antigen (D) Hepatitis B  e-antigen (E) Hepatitis B virus DNA polymerase [Related episode: What Does Academic Infectious Disease Look Like?] [03:35] Thought Process Behind the Correct Answer The correct answer here is C. Remember the actual viral structures. Hepatitis D envelops single-stranded RNA virus. It can't make its own surface antigens. So it requires Hepatitis B surface antigen. Hepatitis D can only be acquired either by co-infection or superinfection of an HPV carrier of co-infection. But this only resolves in 2% of the cases. HPV is a virulent pathogen.  Superinfection results in chronic hepatitis in over 90% of cases. Often, hepatitis with rapid progression of cirrhosis in about 80% of cases. But the influx of this type of viral infection has significantly declined since the development and widespread use of the Hepatitis B vaccine. However, this is still a problem in developing countries. In a lot of underdeveloped countries, it's passed on through migrants from more developed countries. It's therefore important for people to be aware of their Hepatitis B immunity and their potential for this really virulent superinfection. [Related episode: USMLE and COMLEX Prep: Tropical Medicine—Dengue Fever] [07:35] Understanding the Wrong Answer Choices Hepatitis pX is pX protein of Hepatitis B virus. It's implicated in viral transcription, replication, and increased risk of hepatocellular carcinoma through the expression of this X protein gene. The core antigen is the indicator of active viral replication. It's also a determinant of whether an individual is able to transmit the infection. But this is not the necessary component for the protein. Hepatitis B e-antigen can act as a marker of our replication infectivity but this isn't the necessary component either. Hepatitis B virus DNA polymerase is not necessary for HPV to replicate. HPV is the host hepatocyte, while the polymerase works to produce that complementary RNA. Links: BoardVitals  (Use the promo code BOARDROUNDS to save 15% off.) Specialty Stories

Session 23 We're joined by Dr. Karen Shackelford from BoardVitals as we tackle a neuro question this week. Maximize your Step 1/Level 1 prep by checking out BoardVitals. They have an amazing QBank that contains targeted questions. If you have a question about a question or explanation, for instance, simply click a button. This will allow you to ask a doctor and get a response within 24-48 hours. Use the promo code BOARDROUNDS to save 15% off. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:13] Question of the Week A patient has a decreased level of consciousness and they're testing the gag reflex. The elevation of the soft palate is symmetric when he touched the left side. But when he touched the right side, there's no response. Which of the following is true relating to this patient's condition? (A) The glossopharyngeal nerve carries efferent fibers that mediate the gag reflex. (B) The ideology of that absent reflex is a lesion of the right glossopharyngeal nerve. (C) The cause of the patient's absent reflex is a lesion of the left vagus nerve. (D) The reflex is mediated through the dorsal motor nucleus of the vagus. (E) Both the glossopharyngeal nerve and the vagus nerve are damaged on the right side. [Related episode: USMLE and COMLEX Prep: Glossopharyngeal Nerve Anatomy] [02:11] Thought Process Behind the Correct Answer The correct answer here is B. The motor limb is mediated by the vagus nerve. Sensory, however, is mediated by the glossopharyngeal nerve. The vagus nerve also carries some sensory fibers through the recurrent laryngeal. If the gag reflex is intact, the soft palate will rise symmetrically regardless of which side is touched. If both the glossopharyngeal and the vagus are damaged on one side, there is no response when touching the contralateral side. The soft palate will rise unilaterally on the side that's intact. Also, there won't be any response whenever you're testing the affected side of the lesion if both nerves are damaged. The vagus nerve is the only nerve damaged and there's a lesion on the single side of it. And the soft palate rises and pull to the intact side. Regardless of the pathway, this is something worth remembering. If the glossopharyngeal is only damaged on a single side, there's not going to be a response on either side when you test the reflex on the affected side. This is because you're not receiving the sensory impulse. Whenever you test the intact side, the palate will rise on both sides because the motor fibers of the vagus nerve are still intact. [06:40] Understanding the Other Answer Choices The afferent fibers of the glossopharyngeal nerve mediate the sensory component of the gag reflex. Hence, answer choice A is wrong. For C, if the left vagus nerve or the motor nerve was damaged on the left side resulting in an elevation of the soft palate on the right no matter which side was tested. In other words, this is the lateral lesion of vagus nerve. There's also the elevation of the soft palate to the contralateral side regardless of which side you're testing. For option D, this is also wrong because the reflex is mediated through the nucleus ambiguus. For E, if that were the case, then there would be no response at all when testing the right side or the side of the lesion. There would also be no response when testing the left side because the motor portion is damaged on the side of the lesion. Hence, there'd be an asymmetric elevation of the soft palate on the contralateral side. [08:45] BoardVitals Maximize your Step 1/Level 1 prep by checking out BoardVitals. They have an amazing QBank that contains targeted questions. If you have a question about a question or explanation, for instance, simply click a button. This will allow you to ask a doctor and get a response within 24-48 hours. Use the promo code BOARDROUNDS to save 15% off. Links: BoardVitals  (Use the promo code BOARDROUNDS to save 15% off.)

Session 17 Dr. Karen Shackelford from BoardVitals is joining me once again for another round of discussion. This week, we tackle a certain kind of pediatric illness. [01:11] Question of the Week: A 10-year-old male patient is evaluated for abdominal pain he has had for two days. He has a rash on his buttocks and thighs. It appeared about three days ago. He's also complaining of some pain in his ankles and knees. His past medical history is unremarkable. But he was seen in the clinic two weeks ago with symptoms of an upper respiratory infection. On physical exam, his abdomen has standard palpation. 01:42  He has multiple palpable purpuras on his buttocks and upper thighs. 01:50 His ankle is swollen and tender on the right. There's no warrant for eczema. His knee is tender. But otherwise, his exam was unremarkable. His laboratory study is showing a normal CBC. On urine 02:09, he has microhematuria. What is the most likely diagnosis? (A) IgA vasculitis (formerly Purpura) (B) Hemolytic uremic syndrome (C) Kawasaki disease (D) Acute post-streptococcal glomerulonephritis [03:40] Thought Process The correct answer here is IgA vasculitis. The palpable purpura on the buttocks and lower extremities is one of the criteria you have to have for purpura, without thrombocytopenia. The other symptoms this patient has, where you could have one or all of these other symptoms, including polyarthralgia, usually in the hip, ankle, and/or knee joints. GI symptoms include abdominal pain, nausea, vomiting, 05:26  or intussusception. Thi has renal involvement, without thrombocytopenia or coagulopathy. These are the two big things. As mentioned, the CBC was normal and he did have the proliferative glomerulonephritis, which occurs with the IgA deposition in the glomeruli. Leukocytoclastic vasculitis is characterized by leukocytes. Neutrophils or monocytes are around the small vessels – the arterioles and venules. There's IgA deposition. There can be IgG or IgM. There is complement C through a deposition. This is what you would see in a biopsy. The lesions are generally in the GI tract or in the skin (which are typically the ones that are biopsied). But if the patient does develop the glomerulonephritis, renal biopsy will show that. That doesn't develop in every case. The disorder is self-limited so treatment-supportive. It's an immune complex seen usually after an upper respiratory infection. In one case series, it has been associated with the MMR vaccine, although this might not have been held up in the later studies. This is also common between the ages of 3 and 11. One of the diagnostic criteria is that the patient has to be under 20. [07:35] Going Through Other Answer Choices In hemolytic uremic syndrome, you can have 07:41 purpura, although they're non-palpable and they're palpable in an 07:49 purpura. That occurs in hemolytic uremic syndrome due to thrombocytopenia. And this patient has a normal CBC. Hemolytic uremic syndrome is usually associated with E.coli infection in the previous case of diarrhea. But there's no history of that in the patient. There is abdominal pain but the rash is not limited to the lower extremities and buttocks. That is characteristic of HSP IgA vasculitis. Kawasaki disease usually occurs in children under the age of 4. The case will usually present a child of Asian descent. It's more prevalent in Japanese children who are at a high risk of IVIG resistance. They will generally have conjunctivitis and fever for more than 5 days. They have that strawberry tongue. The skin manifestations are non-palpable purpura, but there are periungual desquamation and hand-and-foot erythema. Acute post-streptococcal glomerulonephritis can present with hematuria. It can occur after a skin infection or a pharyngeal infection. That was meant to be with a rash. Maybe someone will consider this because there's a rash involved. As group-A beta-hemolytic strep, this patient had a previous upper respiratory infection which could potentially have been caused by strep. But arthralgia isn't common. Abdominal pain isn't common. And the purpura also not associated with acute post-streptococcal glomerulonephritis. [11:10] BoardVitals If you're looking for a QBank in preparing for your board, check out BoardVitals. They have over 1700 questions for Step 1 and over 1500 questions for Level 1 with detailed explanations behind every question and every answer. Use the promo code BOARDROUNDS to save 15% off. Links: BoardVitals (promo code BOARDROUNDS to save 15% off)

Session 16 We're joined once again by Dr. Karen Shackelford from BoardVitals. This week, we discuss a case about an immigrant from Central America who's pregnant. [01:30] Question of the Week: A 26-year-old, G1P0 female is a recent immigrant from Central America and she presents with crampy abdominal pain and vaginal bleeding. By her dates, because she hasn't received prenatal care. She's of 25 weeks gestation and her past medical history is unremarkable. She takes an over-the-counter multivitamin but no other medication. She denies alcohol, tobacco, or illicit drug use. And she spontaneously delivers a stillborn fetus. The fetus is noted to have microcephaly and imaging performed reveals thinning of the cerebral cortices, ventriculomegaly, and subcortical calcifications. Viral RNA is identified in both maternal and fetal body fluids. The virus is a neurotropic virus that disrupts proliferation migration and differentiation of neural precursor cells in the developing fetus. Which of the following is the most likely pathogen? (A) Herpex simplex virus (B) Rubella (C) Zeka virus (D) Cytomegalovirus (CMV) [03:50] Thought Process The pathogen here is Zeka virus. CMV is a pretty good distraction here since the question mentioned ventricular calcification. But with respect to being a neurotropic virus, Zeka is and has been in the news a lot. It's a single-stranded RNA virus transmitted by mosquitoes. It's also related to dengue virus and the yellow fever virus. The infection results in clinical manifestations in about 20% of people and the rest would not know they've had it. If you're infected, you're symptomatic. You have a low-grade temp. You can develop a maculopapular rash, arthralgia, and conjunctivitis. There are other neurologic complications besides the general microcephaly. You can end up with Guillain-Barre, myelitis, meningoencephalitis, seizures, and congenital spasticity which the mother has vertically transmitted during delivery or it can be transmitted through the placenta. It can also be sexually transmitted and through other body fluids. It can also be caused by laboratory exposure such as the transplant of infected organs. It's fairly infectious. [05:42] Pregnant Women Should Avoid Infested Areas Pregnant women in the United States have been advised across the board to avoid travel in regions where mosquito transmission of Zeka occurs if they're going to be less than 6500 feet in altitude. This is the same thing with malaria in some parts of Kenya. [06:12] Understanding the Other Viruses CMV is a double-stranded DNA virus. The question mentioned specifically that the virus was an RNA virus. So this would be one reason you would disqualify CMV from your correct answers. But general CMV infection can result in chorioretinitis, hearing loss, jaundice, and periventricular calcification on imaging studies. CMV is not associated with tropical travel or immigration. Rubella is a single-stranded RNA virus. Congenital exposure is primarily associated with hearing loss, cataracts and congenital cardiac defects instead of neurological defects. HSV is a double-stranded DNA virus. Congenital exposure is associated with skin lesions and obstruction of brain tissue. The candidate here can rule out HSV for no other reason than it's a DNA virus. [07:55] Expand Your Knowledge and Be Up-to-Date Zeka has been in the news a lot lately. And content gets updated on USMLE. So you should be aware of these things even if you just hear about them once or twice while you're studying. You're more likely to diagnose it than if you don't remember hearing about it at all during your studies. "You have to be aware of what is potentially out there because you can't diagnose something you don't think of." [08:40] BoardVitals Check out the QBanks at BoardVitals.com. With over 1700 questions for Step 1 and over 1500 questions for Level 1, you will have plenty of content to cover to make sure that you are prepared for your board exam. You board exam score is vital for you to be able to match into your specialty of choice. So there is no such thing as being over prepared for your board exams. Start now. Sign up for a 6-month plan or a 3-month plan. Get started early. Get through the content because the more questions you do, the better you do on your board exams. Use the promo code BOARDROUNDS to save 15% off. Links: BoardVitals (promo code BOARDROUNDS to save 15% off)

Session 15 This week, we're joined by Dr. Karen Shackelford from BoardVitals. If you're looking for more prep with your USMLE Step 1 or COMLEX Level 1 training, visit BoardVitals and check out their QBanks for Step 1 and Level 1. Sign up for either 3 months, 6 months, or even 1 month. Your signup will have a vaccine donated through the #GiveVax program. If you sign up for the 3 months and 6 months, you'll get access to Ask a Clinician, where you can connect with the BoardVitals medical experts to answer your content questions. Use the promo code BOARDROUNDS to save 15% off of your purchase. [02:17] About Dr. Karen Shackelford Karen is a former ER clinician. She did her residency in medical school at the University of Mississippi. She eventually moved to Pennsylvania and began working remotely with BoardVitals as a contributor and editor. [03:20] Question of the Week A 35-year-old female patient returned 10 days ago from a mission trip to Nigeria. He was evaluated in the clinic a week ago, complaining of a high fever. She had a rash on the axilla, face, and extremities. The symptoms she had experienced were similar to some she had two years earlier after returning from the same mission trip. Those symptoms resolved with only symptomatic treatment. Today, her husband took her to the emergency department reporting that her fever had resolved two days ago. But she began to complain about abdominal pain and then she appeared very lethargic. On exam, her skin is cool and blocky. She had circumoral sinuses. Her pulse is weak and rapid. And her blood pressure is 80/60 mm Hg. She has a diffused confluent rash and her liver 2 cm below the costal margin. Laboratory studies are significant for a platelet count of 70,000 cells/mL. White blood cell count is 2,000 cells/mL with predominant lymphocytosis. Her serum aminotransferase is elevated. Which of the following is most likely caused by these severe symptoms? (A) Has bacterial super infection (B) Inoculation with a larger viral load (C) Antigenic drift (D) Different viral serotype change [05:08] Thought Process Behind the Answer Antigenic drift is characterized by small changes in the viral structure. It denotes spontaneous changes in the viral type. This is how viruses avoid getting destroyed by vaccines. Serotype is defined as a serologically different strain of microorganism with slight structural differences. They're classified together and have the same type of immune response. But just with a slight variation in their effect on the immune system. The correct answer here is D. The patient, in this case, is her second infection with Dengue Virus but with a different serotype. There are four serotypes of that virus. It's not atypical for somebody to have a mild case that resolves or even asymptomatic initial infection. At that time, the virus presents to a naive immune system. The second time around, it triggers a more significant immune response instead of immunity because of the antigenic differences that the virus responds to. A lot of these viruses are becoming more common in areas that people routinely travel to. A severe viral infection can resolve in hemorrhagic fever and epistaxis, hepatomegaly, circulatory shock. And it resolves through increased capillary permeability because the immune system is having a fluoric response to this second exposure to a slightly different serotype. [10:05] Third Infection If she had a third infection with Dengue Virus, it could be another viral serotype which can be potentially harmful. Although you might have some measure of immunity against the same one. When somebody comes into the office in the Emergency Department with a history of travel to the tropics and they have fibromyalgia, lethargy, and a rash, there are several things that could be wrong with them. Check on Chikungunya fever or dengue fever. They should be considered. But the one that is potentially fatal is dengue. The person could seem to recover. The fever could resolve. They could also become progressively ill and have circulatory collapse several days later. Hence, they should be monitored closely after an episode. The tests for these two are not readily available in those hospitals. So close monitoring should be done if they're coming with acute high fibromyalgia, lethargy, and rash after a trip to the tropics. [11:50] Potential Questions Both fevers are viral and both transmitted by the Aedes mosquito. There's not a vaccine and not a specific treatment. It's just supported. In most cases, the initial infection is asymptomatic or mild asymptomatic. Increased formation in immune complex so she has a pretty flourid response to dengue fever would be the primary mechanism behind it. Again, no specific treatment. Links: BoardVitals (promo code BOARDROUNDS to save 15% off)

Session 03 Board Rounds is back with BoardVitals and Dr. Andrea Paul to discuss when you should start preparing for the USMLE Step 1 and COMLEX Level 1 exams. This week, we're going to dive into when you should start preparing for these exams. The Step 1/Level 1 are going to be one of the most important pieces in your residency journey. And so we need to make sure you're preparing as best as possible and when you start doing that. [02:11] When to Start Thinking About Preparing for the Boards Sit down and start with setting a goal. Which specialty are you planning to apply to or would you like to be able to apply to? What's the minimum score would you feel is acceptable or competitive for those areas. Then look at your schedule to see what time you're available or what time do you want to dedicate for studying. And sticking to that is really important. Be present and work harder on those hours. Always have some flex days, especially towards the end. [04:49] Setting Dedicated Time You need to schedule dedicated time during all those classes. So if you're doing biochemistry, you need to carve out an hour on few days a week where you're going to do biochemistry related questions on your USMLE prep materials. This way, you're able to connect them earlier. To help you score higher, start preparing early. Know what scores you need and test yourself to see if you're getting towards that. "If you start making those connections early... it all helps you down the road." [08:30] What Resources to Use and Average Study Time Andrea thinks that paper textbooks are not always the most user-friendly. The great thing about online resources is that you can take them anywhere. You also get to customize what you're learning. Most students study for Step 1 during their preclinical curriculum, during the first year of medical school. And then the intensity increases during that dedicated time. Most of them would average 11 hours of studying per day for 35 days, usually covering 4000 practice sessions during that amount of study time. "Most students now are averaging about 11 hours of studying per day for Step 1 and that's for about 35 days. That's an incredible number of hours to study." Moreover, their data says that the number of days people study didn't correlate with their scores. Right around the midpoint was when the scores were highest. But students think more and more is better. So this is something to keep in mind. Also, their strongest correlation with high scores is the number of practice questions they took and their grades in school. Ultimately, Andrea says it's all about a combination of someone's work ethic and being a good test-taker that leads to a good score. [14:42] Simulating the Test Environment and Eliminating Distractions When you're interrupted with a text message or when you're on your phone, it takes about 15-20 minutes to get back into the flow of where you were before that interruption. if you add those three into an hour, well, it's not a very effective hour, isn't it? It is therefore important to simulate the test environment. When you're in a question bank and doing questions, you're not going to have the phone or someone knocking on the door, or any distractions. That being said, you want to make the most of your study time. Put that phone somewhere else or turn it off. And simulate that same environment as much as you can. Even when you need to utilize your resource online, don't have other things or windows open. Keep a spreadsheet maybe open and just minimized so you could take notes. Avoid breaking up the actual studying with looking up some side information you might have thought of. Instead, keep that checklist and make quick notes of what you need to go back or what you need to go and review more on. Otherwise, it's best not to open another tab or window. "It's will power but it's a month of your life and it will be worth it and you'll be glad that you didn't worry about your social media for a few days." [18:38] Practice Questions and Reviews Just use the question bank and there's a sheer number of questions you can look at and practice to help you. Again, this was the strongest correlation with the high score. So look at it as doing blocks of questions in different ways. For instance, today, look at the cardiovascular system and do a full day of questions in that area. This way, you're randomizing different materials and your mind has to go to all those different places. Additionally, after answering the question, immediately click a box to open the explanation to see if you're right or wrong and why. Their explanation will then go through each option why it was not the correct answer. This is the best way to start out since you're still in the knowledge-gathering phase, more so than the assessment phase. Then as you progress and you see your scores get closer to your goal, that's the time you can go to the test mode and do more assessment. With BoardVitals, you can create any length of the exam you like and any format you like. So you can set your own time. On average, the time students spend on each question is based on about a minute and a half. If you focus around that minute mark, that's going to get you finished on time. [23:44] Predicting Your Score Andrea says you can't really predict that but you can't fully simulate a real test environment or each person's knowledge on the specific topics they're going to get on that day. There's always going to be variation.Finally, just do as many questions as possible and even if the topic may not be exactly the same. [28:00] Manage Your Life "Make sure that dedicated study time is truly dedicated as possible." Exercise. Start your day doing something active. This way, you're going to enhance your ability to retain knowledge so much more than just staring for four to five hours. It's really all about being intentional with your day to set yourself up to success. Use the promo code BOARDROUNDS to sign up and get 15%. In every sign up, BoardVitals will donate a vaccine to a child in need through the GIVEVACS program. Links: BoardVitals