Dr.Rana Saqlain Shoukat

28/07/2026

28/07/2026

A 49-year-old woman with recurrent episodes of acute pancreatitis is reviewed in the lipid clinic. She has familial chylomicronemia syndrome (FCS) confirmed by genetic testing, with biallelic pathogenic variants in the LPL gene. Despite strict dietary fat restriction (

07/07/2026

50 diagnoses cover the majority of high-yield musculoskeletal conditions repeatedly tested across USMLE

1. Osgood-Schlatter disease – Adolescent athlete, tibial tubercle pain, worse with jumping.
2. Legg–Calvé–Perthes disease – Boy 4–8 years, avascular necrosis of femoral head, painless limp.
3. Slipped capital femoral epiphysis – Obese adolescent, hip pain referred to knee, externally rotated leg.
4. Developmental dysplasia of the hip – Positive Ortolani/Barlow, asymmetric skin folds.
5. Septic arthritis – Hot swollen joint, inability to bear weight, S. aureus.
6. Osteomyelitis – Bone pain + fever, S. aureus most common.
7. Ewing sarcoma – Onion-skin periosteum, t(11;22).
8. Osteosarcoma – Sunburst appearance, Codman triangle, around knee.
9. Osteochondroma – Most common benign bone tumor, cartilage-capped exostosis.
10. Giant cell tumor of bone – Soap-bubble appearance, epiphysis, multinucleated giant cells.
11. Plantar fasciitis – Heel pain with first steps in the morning.
12. Achilles tendinopathy – Posterior heel pain, overuse.
13. Achilles tendon rupture – Sudden pop, positive Thompson test.
14. Patellofemoral pain syndrome – Anterior knee pain, stairs, movie theater sign.
15. Patellar tendon rupture – Cannot extend knee after jump.
16. Anterior cruciate ligament injury – Non-contact pivot injury, Lachman test.
17. Posterior cruciate ligament injury – Dashboard injury, posterior drawer.
18. Medial collateral ligament injury – Valgus stress injury.
19. Lateral collateral ligament injury – Varus stress injury.
20. Meniscal tear – Locking/catching, McMurray test.
21. Rotator cuff tear – Unable to abduct, positive drop-arm test.
22. Shoulder impingement syndrome – Positive Neer/Hawkins tests.
23. Adhesive capsulitis – Diabetes, loss of active and passive ROM.
24. Shoulder dislocation – Most common, axillary nerve injury.
25. Lateral epicondylitis – Tennis elbow, wrist extension pain.
26. Medial epicondylitis – Golfer’s elbow.
27. Carpal tunnel syndrome – Median nerve, thenar atrophy, positive Phalen/Tinel.
28. De Quervain tenosynovitis – Thumb pain, positive Finkelstein test.
29. Trigger finger – Finger locking due to A1 pulley.
30. Dupuytren contracture – Palmar fibrosis, 4th/5th fingers.
31. Compartment syndrome – Pain out of proportion, pain with passive stretch.
32. Fat embolism syndrome – Long bone fracture + petechiae + hypoxemia.
33. Complex regional pain syndrome – Severe pain after injury, autonomic changes.
34. Paget disease of bone – ↑ALP, hearing loss, enlarged skull.
35. Osteoporosis – Fragility fractures, normal calcium.
36. Osteomalacia – Vitamin D deficiency, Looser zones.
37. Rickets – Bowed legs, rachitic rosary.
38. Avascular necrosis – Steroids, alcohol, sickle cell disease.
39. Fibromyalgia – Widespread pain, fatigue, normal inflammatory markers.
40. Polymyalgia rheumatica – Older adult, shoulder/hip stiffness, ↑ESR, responds to steroids.
41. Rheumatoid arthritis – MCP/PIP symmetric arthritis, morning stiffness >1 hour.
42. Osteoarthritis – DIP joints, Heberden nodes, worse with use.
43. Gout – First MTP, needle-shaped negatively birefringent crystals.
44. Calcium pyrophosphate deposition disease – Chondrocalcinosis, positively birefringent rhomboid crystals.
45. Ankylosing spondylitis – HLA-B27, bamboo spine, uveitis.
46. Psoriatic arthritis – Dactylitis, nail pitting, pencil-in-cup deformity.
47. Reactive arthritis – Can’t see, can’t p*e, can’t climb a tree.
48. Systemic lupus erythematosus – Non-erosive arthritis with multisystem disease.
49. Dermatomyositis – Heliotrope rash, Gottron papules, proximal muscle weakness.
50. Polymyositis – Symmetric proximal muscle weakness, elevated CK.

07/07/2026

A 67-year-old woman presents to the emergency department with sudden-onset dyspnea and pleuritic chest pain. She is 7 days post–total hip replacement. On examination, BP is 78/48 mmHg, HR 128/min, RR 30/min, and oxygen saturation 86% on room air. CT pulmonary angiography confirms a large bilateral pulmonary embolism. Bedside echocardiography shows right ventricular dilatation. She has no history of recent intracranial hemorrhage, stroke, or active bleeding.

What is the most appropriate next step in management?
A. Low-molecular-weight heparin
B. Catheter Directed Therapy
C. Systemic thrombolysis with alteplase
D. Inferior vena cava (IVC) filter placement
E. Surgical Embolectomy

07/07/2026

A 62-year-old man with a 15-year history of type 2 diabetes mellitus presents for routine follow-up. He reports mild fatigue but no vomiting or diarrhea. Medications include lisinopril and metformin. Blood pressure is 132/78 mmHg.

Serum sodium: 138 mmol/L
Serum potassium: 6.1 mmol/L
Serum bicarbonate: 18 mmol/L
Creatinine: 1.6 mg/dL
Arterial blood gas: Mild metabolic acidosis with normal anion gap

Which of the following is the most likely diagnosis?

A. Type 1 renal tubular acidosis
B. Type 2 renal tubular acidosis
C. Type 4 renal tubular acidosis
D. Diabetic ketoacidosis
E. Primary adrenal insufficiency

04/07/2026

Iron Replacement Dose Calculation
Use Either Ganzoni Formula or Simplified IV Iron Dosing

Ganzoni Formula
Total Iron Deficit (mg) = Body Weight (kg) × (Target Hb − Actual Hb in g/dL) × 2.4 + Iron Stores

04/07/2026

A 34-year-old woman presents with central obesity, purple striae, proximal muscle weakness, and hypertension. Initial tests show:

—-24-hour urinary free cortisol: elevated
—-Low-dose dexamethasone suppression test: no suppression

—Plasma ACTH is elevated.

What is the next best step in workup?

A. High-dose dexamethasone suppression test
B. CT abdomen
C. MRI pituitary
D. Inferior petrosal sinus sampling
E. Serum DHEAS level

04/07/2026

Differential Diagnosis of Rheumatoid Arthritis

Rheumatoid Arthritis Mimickers

—Systemic Lupus Erythematosus
—Psoriatic Arthritis
—Viral arthritis (especially Parvovirus B19 Infection and Hepatitis C)
—Crystal arthritis (especially Calcium Pyrophosphate Deposition Disease and Gout)
—Hemochromatosis
—Erosive osteoarthritis
—Reactive arthritis
—Sarcoidosis
—Systemic sclerosis / mixed connective tissue disease

Clues favoring RA

—Symmetric MCP and PIP involvement
—Sparing of DIP joints (typical)
—Morning stiffness >1 hour
—Positive RF and anti-CCP (anti-CCP more specific)
—Erosive changes on imaging
—Chronic progressive course
—Rheumatoid nodules or extra-articular manifestations may be present

04/07/2026

A 45-year-old woman presents with confusion, petechiae, and fatigue. Blood tests show:

Hb 7 g/dL
Platelets 18,000/µL
Creatinine mildly elevated
Blood film: schistocytes
PT/aPTT normal

What is the most appropriate immediate management?

A. Fresh frozen plasma
B. IV steroids
C. Urgent plasma exchange
D. Platelet transfusion
E. Vitamin K