One Stem at a Time: High-Yield Board Review for Medical Students

Not every patient who passes out has true syncope, and not every episode of syncope is benign. In this episode of One-Stem at a Time, we explore the major causes of syncope, from common reflex-mediated episodes to life-threatening cardiac conditions.Through practice question stems, we review key clinical clues, distinguish true syncope from its mimics, and discuss the diagnostic workup and management of transient loss of consciousness.In this episode, we go over (spoilers ahead):​The pathophysiology and major etiologies of syncope: reflex, orthostatic, and cardiac​The classic presentations and management of common and high-risk causes of syncope​How to distinguish true syncope from mimics such as seizures and hypoglycemia​Key red flags, diagnostic approaches, and next steps in management​High-yield question-stem clues, common distractors, and second-order reasoning points

Dementia Series – Part 1: Alzheimer's DiseaseIn the first episode of our dementia series, we break down Alzheimer's disease, the most common cause of dementia. We explore the underlying pathophysiology of beta-amyloid plaques and hyperphosphorylated tau neurofibrillary tangles, the role of hippocampal degeneration, and the genetic associations involving APOE ε4, APP, and presenilin mutations. We also review the clinical presentation, diagnostic evaluation, and treatment options, including cholinesterase inhibitors, memantine, and newer anti-amyloid therapies.Whether you're preparing for Step 1, Step 2, or simply strengthening your clinical foundation, this episode connects the biochemistry, neuroanatomy, and clinical medicine behind Alzheimer's disease — one stem at a time.

In this episode of One Stem at a Time, we break down one of the most commonly tested—and clinically important—renal topics: acute kidney injury (AKI).We’ll take a systematic approach to the three major categories of AKI: pre-renal, intrinsic renal, and post-renal, with a closer look at important intrinsic causes including acute tubular necrosis (ATN) and acute interstitial nephritis (AIN). We’ll also unpack the clinical reasoning behind using fractional excretion of sodium (FeNa) and fractional excretion of urea (FeUrea) to help distinguish different causes of AKI.Whether you're studying for an exam, brushing up on renal physiology, or looking to strengthen your clinical approach, this episode will help you work through AKI one stem at a time.

A young patient presents with acute chest pain and findings concerning for acute coronary syndrome—but something about the case doesn’t quite fit the usual picture.In this episode of One Stem at a Time: High-Yield Board Review Podcast, we work through a challenging “zebra” presentation step-by-step, using the history, risk factors, ECG, and clinical clues to uncover an uncommon cause of myocardial infarction.In this episode, you'll learn:How to approach ACS in a patient who doesn’t fit the typical risk profileThe key clinical clues that point toward an uncommon diagnosisImportant associations and underlying pathophysiologyHow to interpret the relevant diagnostic findingsThe management principles that separate this condition from typical ACSHigh-yield board-style pearls you can take straight to your next questionCan you identify the diagnosis before the reveal?

Today we covered eight of the most testable vasculitides by recognizing their clinical patterns instead of memorizing isolated facts. If you can distinguish upper airway disease, asthma, hepatitis associations, vessel size, ANCA status, and immune complex deposition, you'll be able to answer the vast majority of vasculitis questions on Step 1, Step 2, COMLEX, and Internal Medicine shelf exams.Until next time, keep studying one stem at a time.In Episode 3 of our Rheumatology Review Series, we tackle one of the highest-yield topics in rheumatology: vasculitis.Rather than memorizing endless lists, this episode focuses on recognizing the clinical patterns that let you diagnose vasculitis quickly on USMLE Step 1, Step 2, COMLEX, and Internal Medicine shelf exams.We break down the major large-, medium-, and small-vessel vasculitides, including:Granulomatosis with polyangiitis (GPA) – c-ANCA/PR3, sinus disease, cavitary lung nodules, and pauci-immune glomerulonephritisMicroscopic polyangiitis (MPA) – p-ANCA/MPO, pulmonary hemorrhage, and RPGN without granulomatous diseaseEosinophilic granulomatosis with polyangiitis (EGPA) – asthma, eosinophilia, neuropathy, and cardiac involvementGiant cell arteritis (GCA) – headache, jaw claudication, vision loss, and its connection to polymyalgia rheumaticaTakayasu arteritis – the classic young woman with diminished pulses and unequal blood pressuresPolyarteritis nodosa (PAN) – medium-vessel disease, microaneurysms, neuropathy, hypertension, and hepatitis BIgA vasculitis – palpable purpura, abdominal pain, arthralgias, and renal diseaseCryoglobulinemic vasculitis – hepatitis C, palpable purpura, neuropathy, low C4, and positive rheumatoid factorWe'll also cover:Pauci-immune vs. immune complex vasculitisANCA patterns and their antigen targetsThe organ involvement you can't afford to missInduction and maintenance immunosuppressionPCP prophylaxis during immunosuppressive therapyHigh-yield board pearls and rapid-fire questionsBy the end of the episode, you'll have a framework for recognizing vasculitis based on vessel size, organ involvement, ANCA status, immune complexes, and key clinical associations—instead of relying on memorized lists.Learn medicine one clinical vignette at a time.Follow One Stem at a Time for more board-review episodes covering high-yield topics for medical students and residents.

Autoimmune diseases don't have to be overwhelming. In Episode 2 of the One Stem at a Time Rheumatology Review Series, we work through high-yield board-style clinical vignettes covering systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), systemic sclerosis, CREST syndrome, Sjögren syndrome, granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA), and giant cell arteritis (GCA).Each case emphasizes the classic board patterns you'll need to recognize on USMLE Step 1, Step 2 CK, COMLEX, and Internal Medicine shelf exams, including key antibodies, laboratory findings, distinguishing clinical features, and first-line management.Topics covered:SLE: anti-dsDNA vs anti-Smith, lupus nephritis, hydroxychloroquineDrug-induced lupus and anti-histone antibodiesAntiphospholipid syndrome: thrombosis, recurrent pregnancy loss, warfarin vs DOACsDiffuse systemic sclerosis vs CREST syndromeSjögren syndrome and lymphoma riskGPA (c-ANCA/PR3) vs EGPA (asthma + eosinophilia)Giant cell arteritis and why steroids should never be delayedLightning-round antibody and disease associations📚 Bonus: High-yield Harrison's Anki cards summarizing these diseases are included in the episode description for additional spaced-repetition practice.SLE: https://drive.google.com/file/d/1dSHu3rHTH3qNv3dhtcEM2Dt6ZRNNMRV6/view?usp=sharingAPS: https://drive.google.com/file/d/1DOflqLQ67zaFxjlMRsE6aV9ggZ6DcbrM/view?usp=sharing

Anki Cards: Gout & Crystal Arthropathy: https://drive.google.com/file/d/10DkylDtLfZXnu6gg5cmk5yJYxKCEiJbw/view?usp=drive_linkJoint pain is one of the most common presentations you'll encounter on the USMLE, COMLEX, shelf exams, and clinical rotations. In this episode of One Stem at a Time, we work through high-yield board-style clinical vignettes covering the most commonly tested inflammatory arthritides and crystal arthropathies.We'll review: • Rheumatoid arthritis • Osteoarthritis • Psoriatic arthritis • Ankylosing spondylitis • Reactive arthritis • Gout • Calcium pyrophosphate deposition disease (CPPD/pseudogout)Along the way, we'll cover the key antibodies, pathophysiology, imaging findings, synovial fluid analysis, first-line treatments, and board pearls that frequently appear on Step 1, Step 2 CK, COMLEX, and internal medicine shelf exams. Through clinical vignettes, you'll learn how to distinguish similar diseases, recognize classic exam presentations, and approach patients the way both board writers and clinicians do.Whether you're preparing for boards or reviewing before rounds, this episode will help you master inflammatory arthropathies.

Amyloidosis can seem intimidating—until you know the pattern. In this high-yield board review, we break down the four major systemic amyloidoses (AL, AA, ATTR, and Aβ2M), including their pathophysiology, classic clinical presentations, diagnosis, and treatment. Through board-style clinical vignettes and exam pearls, you'll learn how to recognize the key clues that point to amyloidosis and identify the protein responsible. Perfect for medical students, residents, and anyone preparing for Step 2, COMLEX Level 2, or Internal Medicine boards.

Not every “classic” presentation comes with a single clear answer. In this surprise Grab Bag episode of random, unrelated topics, we work through three high-yield board exam conditions that test very different parts of clinical reasoning.Through practice question stems, we rapidly review how to recognize the key clues, avoid common traps, and choose the next best step for each condition.In this episode, we go over (spoilers ahead):The pathophysiology, classic presentations, and management of renal artery stenosisHow to distinguish acute stress disorder from PTSD based on timing, symptom duration, and treatment approachThe characteristic presentation, diagnosis, and treatment of tinea capitis, including why topical therapy alone is not enoughHigh-yield question-stem clues, common distractors, and second-order reasoning points for all three conditions.

Green isn't always a good thing...In this episode, we go over the classic pediatric vomiting and bowel obstruction conditions that every medical student needs to recognize.Through practice question stems, we rapidly compare the presentations, imaging findings, and management steps for five high-yield conditions: intestinal atresia, malrotation with midgut volvulus, Hirschsprung disease, meconium ileus, and necrotizing enterocolitis, with a cameo of pyloric stenosis.In this episode, we go over:The physiology and pathology behind pediatric vomiting and bilious emesisComparing and contrasting each condition and identifying them through context clues already given in the questionThe key presenting features, risk factors, imaging findings, and next best steps for each conditionHow to know when to order an abdominal x-ray, upper GI series, abdominal ultrasound, contrast enema, or when to call surgery immediately, and more