Elite NBME concepts outline
Elite NBME concepts outline
Heya!
My name is Denis, I am NBME CBSE, USMLE Step 1 and COMLEX Level 1 private tutor
You can check my website
elitemedicaltutor.com
Concepts that appear on every NBME is a list made by some anonymous student and modified by Reddit
user u/planjum and then by me that includes concepts that repeat on EVERY NBME PRACTICE TEST and
because of that reason, it represent very high-yield CBSE and USMLE Step 1 content.
After I have been sent NBME quests actual.doc file by u/DoctorPapayon on 10.27.2020 I have started to
incorporate it into the outline
I have modified this list and made it as an outline for my students can go through not very well done
incomplete list with a much greater ease
Elite NBME concepts outline 4fc4300cf6404d7cb7dc8c0a819cd984.html[1/3/21, 11:41:22 AM]
,Elite NBME concepts outline
Treat this list as second in high-yieldness after Pathoma chapter 1-3
General pathology
Learn Pathoma chapter 1, 2, 3 by heart!!!
Apoptosis
Pathoma chapter 1
FA 2020 p. 208
Know the most crazy stuff like what is being secreted from T-killers - FasL or TNF alpha
(correct answer TNF alpha, FAS-L is attached)
Elite NBME concepts outline 4fc4300cf6404d7cb7dc8c0a819cd984.html[1/3/21, 11:41:22 AM]
,Elite NBME concepts outline
Apoptosis ATP-dependent programmed cell death.
Intrinsic and extrinsic pathways; both pathways activate caspases (cytosolic proteases)-+ cellular
breakdown including cell shrinkage, chromatin condensation, membrane blebbing, and
formation of apoptotic bodies, which are then phagoq 1tosed.
Characterized by deeply eosinophilic cytoplasm and basophilic nucleus, pyknosis, and karyorrhexis.
Cell membrane typically remains intact without significant inflammation (unlike necrosis).
D A laddering (fragments in multiples of 180 bp) is a sensitive indicator of apoptosis.
Intrinsic Involved in tissue remodeling in embryogenesis. Occurs when a regulating factor is withdrawn
(mitochondrial) from a proliferating cell population (e.g, ! IL-2 after a completed immunologic reaction
pathway -+ apoptosis of proliferating effector cells). Also occurs after exposure to injurious stimuli (eg,
radiation, toxins, hypoxia).
Regulated by Bcl-2 family of proteins. BAX and BAK are proapoptotic, while Bcl-2 and Bcl-xL are
antiapoptotic.
BAX and BAK form pores in the mitochondrial membrane-+ release of cytochrome C from inner
mitochondrial membrane into the cytoplasm -+ activation of caspases.
Bcl-2 keeps the mitochondrial membrane impermeable, thereby preventing cytochrome C release.
Bcl-2 overexpression (eg, follicular lymphoma t[14;18))-+ ! caspase activation-+ tumorigenesis.
Extrinsic (death 2 pathways:
receptor) pathway • Ligand receptor interactions (FasL binding to fas fCD95) or T rF-a: binding to its receptor)
• Immune cell (cytotoxic T-cell release of perforin and granzyme B)
Fas-FasL interaction is necessary in thymic medullary negative selection.
Fas mutations t numbers of circulating self-reacting lymphocytes due to failure of clonal deletion.
Defective Fas-FasL interactions cause autoimmune lymphoproliferative syndrome.
Imrinsic Extrinsic
(mitochondriaU
pathway (deathreceptor)pathway
faslf Cytotoxic
T cell
r{ DNAdamago
Misfoldod
Hypoxra
ROS.
Ra<iation. toxins
prot•ins
1
fas
/
Initiator
jrnFR
• TNf-a
Perfor,n
.
Granzyme
•
B•
pSl actiYalion I caspases
......-- • •:1-
l __.,...
IIAXIBAK l
•:J..!.Cytochrome
C
""e...Be~2
Exec.iio{e',/ Nuclear_
caspases'---. <!? fra~menta~on
1ni1ra101_/)
caspases '- i=
0
8~
.c::::>
Macrophage
Cytopliismic
blell
!fd~ ~
~~
Hypoxia
Where to look
Pathoma chapter 1
First Aid 2020 p. 669
Boards and Beyond
https://boardsbeyond.com/video/step-1/hypoxia
Decreased in oxygen transport to tissues
Hypoxemia
Decrease in free oxygen diluted in blood (↓PaO2)
A-a gradient
Elite NBME concepts outline 4fc4300cf6404d7cb7dc8c0a819cd984.html[1/3/21, 11:41:22 AM]
, Elite NBME concepts outline
HYPOXEMIA
A-a gradient
Normal --► Increased
/\ Response to 100% FiO2
m .....
Hypoxemia
I
I~ .....
.,,.,.. ■-
High altitude ]
Associated with 1'
PC0 1
M-1::iffl:W-----
Most common cause of
hypoxemia
Hypoxemia corrects
D1ffus1on 1mpa1rment
Hypoxemia does not correct•
Wil!NN
---------------
•only large shunts do not
correct completely
CNS depression (e.g.,
brainstem stroke,
narcotic overdose) 1/-
Obesity hypoventilation Interstitial lung disease Q
Muscular weakness Emphysema
Pulmonary vascular
disease
-1,V 1/-
1' cardiac output states {1'
Q transit time through Q
alveolar-capillary
Obstructive lung disease "Blood, water, pus, protein"
membrane)
PE Alveolar collapse (atelectasis,
Mild alveolar filling pleural processes)
diseases ("blood, water, Pulmonary AVMs,
pus, protein") intracardiac shunts
Decrease in oxygen carrying capacity
Problem in hemoglobin of carrying oxygen
Decreased hemoglobin - anemia
Defective hemoglobin - methhemoglobinemia
Ischemia
First Aid p. 210
Arterial and venous
Grade or Stage
First aid 2020 p. 220
Pathoma chapter 3
Grade
how similar tumor tissue is to tissue of origin (differentiantion)
Low grade - high differentiation - less bad
High grade - low differentiation - bad
Grade is less important in terms of prognosis than Stage
Stage
How far cancer spreads
Elite NBME concepts outline 4fc4300cf6404d7cb7dc8c0a819cd984.html[1/3/21, 11:41:22 AM]
Elite NBME concepts outline
Heya!
My name is Denis, I am NBME CBSE, USMLE Step 1 and COMLEX Level 1 private tutor
You can check my website
elitemedicaltutor.com
Concepts that appear on every NBME is a list made by some anonymous student and modified by Reddit
user u/planjum and then by me that includes concepts that repeat on EVERY NBME PRACTICE TEST and
because of that reason, it represent very high-yield CBSE and USMLE Step 1 content.
After I have been sent NBME quests actual.doc file by u/DoctorPapayon on 10.27.2020 I have started to
incorporate it into the outline
I have modified this list and made it as an outline for my students can go through not very well done
incomplete list with a much greater ease
Elite NBME concepts outline 4fc4300cf6404d7cb7dc8c0a819cd984.html[1/3/21, 11:41:22 AM]
,Elite NBME concepts outline
Treat this list as second in high-yieldness after Pathoma chapter 1-3
General pathology
Learn Pathoma chapter 1, 2, 3 by heart!!!
Apoptosis
Pathoma chapter 1
FA 2020 p. 208
Know the most crazy stuff like what is being secreted from T-killers - FasL or TNF alpha
(correct answer TNF alpha, FAS-L is attached)
Elite NBME concepts outline 4fc4300cf6404d7cb7dc8c0a819cd984.html[1/3/21, 11:41:22 AM]
,Elite NBME concepts outline
Apoptosis ATP-dependent programmed cell death.
Intrinsic and extrinsic pathways; both pathways activate caspases (cytosolic proteases)-+ cellular
breakdown including cell shrinkage, chromatin condensation, membrane blebbing, and
formation of apoptotic bodies, which are then phagoq 1tosed.
Characterized by deeply eosinophilic cytoplasm and basophilic nucleus, pyknosis, and karyorrhexis.
Cell membrane typically remains intact without significant inflammation (unlike necrosis).
D A laddering (fragments in multiples of 180 bp) is a sensitive indicator of apoptosis.
Intrinsic Involved in tissue remodeling in embryogenesis. Occurs when a regulating factor is withdrawn
(mitochondrial) from a proliferating cell population (e.g, ! IL-2 after a completed immunologic reaction
pathway -+ apoptosis of proliferating effector cells). Also occurs after exposure to injurious stimuli (eg,
radiation, toxins, hypoxia).
Regulated by Bcl-2 family of proteins. BAX and BAK are proapoptotic, while Bcl-2 and Bcl-xL are
antiapoptotic.
BAX and BAK form pores in the mitochondrial membrane-+ release of cytochrome C from inner
mitochondrial membrane into the cytoplasm -+ activation of caspases.
Bcl-2 keeps the mitochondrial membrane impermeable, thereby preventing cytochrome C release.
Bcl-2 overexpression (eg, follicular lymphoma t[14;18))-+ ! caspase activation-+ tumorigenesis.
Extrinsic (death 2 pathways:
receptor) pathway • Ligand receptor interactions (FasL binding to fas fCD95) or T rF-a: binding to its receptor)
• Immune cell (cytotoxic T-cell release of perforin and granzyme B)
Fas-FasL interaction is necessary in thymic medullary negative selection.
Fas mutations t numbers of circulating self-reacting lymphocytes due to failure of clonal deletion.
Defective Fas-FasL interactions cause autoimmune lymphoproliferative syndrome.
Imrinsic Extrinsic
(mitochondriaU
pathway (deathreceptor)pathway
faslf Cytotoxic
T cell
r{ DNAdamago
Misfoldod
Hypoxra
ROS.
Ra<iation. toxins
prot•ins
1
fas
/
Initiator
jrnFR
• TNf-a
Perfor,n
.
Granzyme
•
B•
pSl actiYalion I caspases
......-- • •:1-
l __.,...
IIAXIBAK l
•:J..!.Cytochrome
C
""e...Be~2
Exec.iio{e',/ Nuclear_
caspases'---. <!? fra~menta~on
1ni1ra101_/)
caspases '- i=
0
8~
.c::::>
Macrophage
Cytopliismic
blell
!fd~ ~
~~
Hypoxia
Where to look
Pathoma chapter 1
First Aid 2020 p. 669
Boards and Beyond
https://boardsbeyond.com/video/step-1/hypoxia
Decreased in oxygen transport to tissues
Hypoxemia
Decrease in free oxygen diluted in blood (↓PaO2)
A-a gradient
Elite NBME concepts outline 4fc4300cf6404d7cb7dc8c0a819cd984.html[1/3/21, 11:41:22 AM]
, Elite NBME concepts outline
HYPOXEMIA
A-a gradient
Normal --► Increased
/\ Response to 100% FiO2
m .....
Hypoxemia
I
I~ .....
.,,.,.. ■-
High altitude ]
Associated with 1'
PC0 1
M-1::iffl:W-----
Most common cause of
hypoxemia
Hypoxemia corrects
D1ffus1on 1mpa1rment
Hypoxemia does not correct•
Wil!NN
---------------
•only large shunts do not
correct completely
CNS depression (e.g.,
brainstem stroke,
narcotic overdose) 1/-
Obesity hypoventilation Interstitial lung disease Q
Muscular weakness Emphysema
Pulmonary vascular
disease
-1,V 1/-
1' cardiac output states {1'
Q transit time through Q
alveolar-capillary
Obstructive lung disease "Blood, water, pus, protein"
membrane)
PE Alveolar collapse (atelectasis,
Mild alveolar filling pleural processes)
diseases ("blood, water, Pulmonary AVMs,
pus, protein") intracardiac shunts
Decrease in oxygen carrying capacity
Problem in hemoglobin of carrying oxygen
Decreased hemoglobin - anemia
Defective hemoglobin - methhemoglobinemia
Ischemia
First Aid p. 210
Arterial and venous
Grade or Stage
First aid 2020 p. 220
Pathoma chapter 3
Grade
how similar tumor tissue is to tissue of origin (differentiantion)
Low grade - high differentiation - less bad
High grade - low differentiation - bad
Grade is less important in terms of prognosis than Stage
Stage
How far cancer spreads
Elite NBME concepts outline 4fc4300cf6404d7cb7dc8c0a819cd984.html[1/3/21, 11:41:22 AM]
