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 profile
• The key clinical clues that point toward an uncommon diagnosis
• Important associations and underlying pathophysiology
• How to interpret the relevant diagnostic findings
• The management principles that separate this condition from typical ACS
• High-yield board-style pearls you can take straight to your next question

Can 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 glomerulonephritis

• Microscopic polyangiitis (MPA) – p-ANCA/MPO, pulmonary hemorrhage, and RPGN without granulomatous disease

• Eosinophilic granulomatosis with polyangiitis (EGPA) – asthma, eosinophilia, neuropathy, and cardiac involvement

• Giant cell arteritis (GCA) – headache, jaw claudication, vision loss, and its connection to polymyalgia rheumatica

• Takayasu arteritis – the classic young woman with diminished pulses and unequal blood pressures

• Polyarteritis nodosa (PAN) – medium-vessel disease, microaneurysms, neuropathy, hypertension, and hepatitis B

• IgA vasculitis – palpable purpura, abdominal pain, arthralgias, and renal disease

• Cryoglobulinemic vasculitis – hepatitis C, palpable purpura, neuropathy, low C4, and positive rheumatoid factor

We'll also cover:

Pauci-immune vs. immune complex vasculitis

ANCA patterns and their antigen targets

The organ involvement you can't afford to miss

Induction and maintenance immunosuppression

PCP prophylaxis during immunosuppressive therapy

High-yield board pearls and rapid-fire questions

By 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, hydroxychloroquine

• Drug-induced lupus and anti-histone antibodies

• Antiphospholipid syndrome: thrombosis, recurrent pregnancy loss, warfarin vs DOACs

• Diffuse systemic sclerosis vs CREST syndrome

• Sjögren syndrome and lymphoma risk

• GPA (c-ANCA/PR3) vs EGPA (asthma + eosinophilia)

• Giant cell arteritis and why steroids should never be delayed

• Lightning-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=sharing

APS: 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_link

Joint 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 stenosis
• How to distinguish acute stress disorder from PTSD based on timing, symptom duration, and treatment approach
• The characteristic presentation, diagnosis, and treatment of tinea capitis, including why topical therapy alone is not enough
• High-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 emesis
• Comparing and contrasting each condition and identifying them through context clues already given in the question
• The key presenting features, risk factors, imaging findings, and next best steps for each condition
• How to know when to order an abdominal x-ray, upper GI series, abdominal ultrasound, contrast enema, or when to call surgery immediately, and more

Not all bleeding disorders are platelet problems! We go over the different conditions that involve abnormalities in secondary hemostasis for the second and final part of this miniseries.

Here, through practice question stems, we do a rapid-review of what secondary hemostasis is, and quickly go over many different potential causes for deficiencies in coagulation factors in less than 24 minutes.

In this episode, we go over:

• The physiology and pathology of secondary hemostasis, the coagulation cascade, and its relevant diseases
• Comparing and contrasting different seconhemostasis disorders in patient presentation and lab findings
• The key treatments for conditions such as VWD, Hemophilias, Hemorrhagic Disease of the Newborn, Vitamin K Deficiency, and DIC.
• Key high-yield USMLE exam traps that often trap students!

Obstructive shock is one of the most testable—and most misunderstood—shock states on boards and in clinical medicine. In this episode of One Stem at a Time, we break it down from first principles so you can stop memorizing arrows and start understanding them.

Through two classic board-style cases—cardiac tamponade and pulmonary embolism—you’ll learn how to recognize obstructive shock, interpret hemodynamic profiles, and confidently work through “arrow questions” involving cardiac index, right atrial pressure, pulmonary capillary wedge pressure, and systemic vascular resistance.

We focus on building a simple, powerful framework: follow the flow of blood, identify where it’s blocked, and let the physiology guide you. Along the way, we highlight key distinctions between tamponade, tension pneumothorax, and massive PE, explain why SVR is increased (even in hypotensive patients), and review how PCWP is measured and applied clinically.

By the end of this episode, you’ll be able to:

• Recognize obstructive shock from clinical presentations and exam clues

• Understand the underlying pathophysiology and compensatory mechanisms

• Interpret hemodynamic “arrow” questions with confidence

• Differentiate tamponade, pulmonary embolism, and tension pneumothorax

• Apply high-yield board strategies and clinical reasoning in real time

Perfect for USMLE and COMLEX prep, clinical rotations, and rapid review before exams.

Not all platelet disorders are created equal. We go over the different conditions that involve abnormalities in primary hemostasis for the first part of this miniseries.

Here, through practice question stems, we do a rapid-review of what primary hemostasis is, and quickly go over five different potential causes for platelet deficiency or dysfunction in less than 22 minutes.

In this episode, we go over:

• The physiology and pathology of primary hemostasis, platelets, and its relevant diseases
• Comparing and contrasting different primary hemostasis disorders in patient presentation and lab findings
• The key treatments for conditions such as ITP, TTP, HUS, and more
• Key high-yield USMLE exam traps that often trap students