AceMedBoards

Helping medical students effectively raise scores for medical board licensing exams and getting into the dream residency of your choice.

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This year, our students matched in:

Plastic surgery, IM, pediatrics, psychiatry, peds, dermatology, general surgery, ortho, FM, anesthesia, prelim and TY, neuro, PM&R, interventional rads, cardio fellowship, sports med fellowship, GI fellowship, OB/GYN.

What a year #MedTwitter

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CO Poisoning – “Silent Hypoxemia”
🔑 PaO2: Normal
🔑 O2 Sat (pulse ox): Falsely normal
🩺 Best Test: CO-oximetry (directly measures carboxyhemoglobin)

⚡️ Pulse ox can’t differentiate CO-bound Hb! Suspect in house fires, faulty heaters.
#USMLEStep2 #COMLEX

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DLCO Interpretation – Quick Review
🔹 ⬇️ DLCO: Emphysema, fibrosis
🔹 ⬆️ DLCO: Polycythemia, hemorrhage

⚡️ Normal DLCO but restrictive? Think obesity or ALS
#USMLEStep1 #COMLEX

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Home O2 for COPD – Criteria
🔹 PaO2 < 55 or O2 < 88%
🔹 Cor pulmonale/polycythemia: PaO2 < 60

⚡️ Home O2 + smoking cessation = survival benefit
#USMLEPrep #medstudent

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Bronchiectasis – When to Suspect
🔑 Sx: Chronic cough, purulent sputum, hemoptysis
🩺 Dx: High-resolution CT (tram-track sign)
🩹 Tx: Chest PT, bronchodilators, inhaled antibiotics

⚡️ MC Cause in US: CF
#USMLEStep2 #COMLEX

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CF Lung Infections – Age Matters
🔹 < 20 years: Staph aureus
🔹 > 20 years: Pseudomonas

⚡️ Tx: Vancomycin (MRSA) or ceftazidime (Pseudomonas)
#medicalstudent #USMLEPrep

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Cystic Fibrosis (CF) – Pulmonary Key Points
🔑 Dx: Sweat chloride test (≥ 60 mEq/L)
🩹 Tx: Dornase alfa, chest PT, inhaled tobramycin

⚡️ Fat malabsorption = pancreatic enzyme replacement
Common lung infections: Staph (kids), Pseudomonas (adults)
#USMLEStep1 #COMLEX

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COPD Exacerbation – Acute Management
🔑 Tx: DuoNeb (albuterol + ipratropium) + IV steroids + azithromycin

⚡️ Macrolides (azithromycin) reduce inflammation + prevent recurrence
5-day steroid course = standard
#USMLEPrep #medstudent

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COPD Treatment – Stepwise Management
1️⃣ Mild: SABA or SAMA (ipratropium)
2️⃣ Moderate: LAMA (tiotropium) or LABA
3️⃣ Severe: LABA + ICS
4️⃣ Very Severe: Oral steroids

⚡️ Oxygen prolongs survival if PaO2 < 55 or O2 < 88%
#USMLEStep2 #COMLEX

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COPD – Spirometry for Diagnosis
🔑 Dx: FEV1/FVC < 0.7 (no full reversibility)
🩺 < 45 y/o? Suspect Alpha-1 Antitrypsin Deficiency

⚡️ Look for early emphysema in the lung bases!
#medicalstudent #USMLEPrep

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LABA Alone – Why Dangerous in Asthma?
❌ LABA monotherapy ⬆️ mortality
🩹 Solution: Always pair LABA (salmeterol) with ICS

⚡️ LABA = bronchodilation; ICS = reduces inflammation
LABA alone worsens exacerbations!
#USMLEStep2 #COMLEX

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ICS Side Effects in Asthma – Prevention
🔹 Thrush – Rinse mouth after inhaled corticosteroids (ICS)
🔹 Long-term: Osteoporosis, adrenal suppression

⚡️ PPI + Calcium/Vitamin D for long-term steroid users
#USMLEStep1 #COMLEX

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Asthma Exacerbation – ER Management
🔑 1st Line: Albuterol + Ipratropium (DuoNeb) + IV steroids
🔑 Severe: IV magnesium (smooth muscle relaxation)
🔑 NBS if CO2 ⬆️ (sign of fatigue): Intubation

⚡️Normal CO2 = BAD (signals impending respiratory failure)
#medicalstudent #USMLEPrep

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Asthma Treatment Ladder – Memorize This!
1️⃣ Mild Intermittent: SABA (albuterol prn)
2️⃣ Mild Persistent: SABA + Low-dose ICS
3️⃣ Moderate Persistent: ICS + LABA or ⬆️ ICS dose
4️⃣ Severe Persistent: ICS + LABA + oral corticosteroids
⚡️ Key: Symptoms > 2x/week = Persistent Asthma

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AERD – Asthma + Polyps + NSAID Sensitivity
🔑 Dx: Aspirin-Exacerbated Respiratory Disease (AERD)
🩹 Tx: Montelukast (LTRA) or zileuton (LOX inhibitor)

⚡️ Aspirin blocks COX → ⬆️ leukotrienes = bronchospasm
Avoid NSAIDs, use selective COX-2 inhibitors
#USMLEStep1 #COMLEX

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Asthma – Normal Spirometry But Still Suspicious?
🔑 Next Step: Methacholine challenge (induces bronchospasm)
🩺 Mechanism: Muscarinic agonist → airway hyperresponsiveness in asthma

⚡️ Most sensitive test for asthma if spirometry is normal!
#USMLEStep2 #COMLEX

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Carbon Monoxide (CO) Poisoning – Deceptive
🔑 PaO2: Normal
🔑 SatO2 (pulse ox): Normal or falsely high
🩺 Test: CO-oximetry (gold standard)

⚡️ Suspect if smoke inhalation, headache, confusion
Normal O2 doesn't exclude CO poisoning!
#medicalstudent #USMLEPrep

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Diffusion Capacity (DLCO)
🔹 ⬇️ DLCO: Emphysema, pulmonary fibrosis
🔹 ⬆️ DLCO: Polycythemia, pulmonary hemorrhage

⚡️ Normal DLCO + Restriction? Obesity, MG, ALS

#medstudent #USMLEPrep

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Spirometry Review – Obstructive vs Restrictive
🔹 Obstructive:
FEV1/FVC < 0.7
⬆️ Lung volumes (air trapping)

🔹 Restrictive:
FEV1/FVC > 0.8
⬇️ Lung volumes (fibrosis)

⚡️ Key: Post-bronchodilator ⬆️ > 12% = Asthma

#USMLEStep2 #COMLEX

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SIBO (Small Intestinal Bacterial Overgrowth)
🔑 Sx: Bloating, macrocytic anemia
🩹 Tx: Rifaximin

🩺 Why? Bacteria ferment nutrients → bloating + vitamin malabsorption.

#USMLEStep1 #COMLEX

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Tropical Sprue – Travel Diarrhea
🔑 Sx: Fatty stools, weight loss
🩹 Tx: Tetracycline + folate

🩺 Why? Post-travel, infectious → malabsorption mimicking celiac.

#USMLEPrep #medstudent