USMLE Step and NCLEX Exam Prep: Buzzwords # 1
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USMLE & NCLEX: Buzzwords
Medical exams are filled with buzzwords and phrases, which can save you a lot of time and help you quickly answer questions correctly when identified.
Buzzwords are specific words or phrases found in question stems that correlate with and describe a particular condition, diagnosis, etc.
The question stems on medical exams are often lengthy, which can be stressful on a timed exam.
Identifying a buzzword within a question stem can help you immediately figure out the topic being tested.
You should keep a list of buzzwords as you learn them, and then read through them once per day as you prepare for an exam or if you simply want to remember them for practical use.
Below are 10 commonly tested buzzwords or phrases seen on medical exams that you should know.
Check out other EZmed Buzzword lectures below!
NCLEX and USMLE Step Exams: High-yield practice notes and buzzword review
1. Apple Core Lesion = Colon Cancer
If a question stem describes a finding on imaging as an “apple core” lesion, then the answer will likely have to do with colon cancer.
While there are other causes to “apple core” lesions, malignancy is the most severe and is what is most commonly tested using this buzzword.
The neoplasm causes colonic narrowing and an irregular lumen that gives an apple core appearance.
Buzzword
Apple Core Lesion = Colon Cancer
NCLEX and USMLE Step Exams: High-yield practice notes and buzzword review for colon cancer
2. Splinter Hemorrhage = Bacterial Endocarditis
Splinter hemorrhages are thin, longitudinal reddish-brown lines underneath the nails (typically fingernails) that look like wood splinters.
Splinter hemorrhages typically run vertically, and they are caused by hemorrhages from damage to the capillaries underneath the nails.
There are several conditions that can cause splinter hemorrhages, but when you see it on an exam it is likely a buzzword for bacterial endocarditis (infective endocarditis).
Bacterial endocarditis is an infection of the inner lining of the heart.
Always consider endocarditis in a patient who has a fever and a history of IV drug use, or who has other risk factors such as prosthetic valve, immunodeficiency, or structural heart disease.
Other symptoms or findings of bacterial endocarditis include chest pain, shortness of breath, heart murmur, Osler’s nodes, Janeway lesions, and Roth spots.
The tricuspid valve is most commonly affected by bacterial endocarditis caused by IV drug use.
Obtain 3 sets of blood cultures and initiate IV antibiotics if there is clinical concern for endocarditis, and make sure to cover for MRSA if there is a history of IV drug use or other risk factors.
Diagnostic work up typically involves an echocardiogram to assess for cardiac vegetations.
Dukes criteria can be used to help diagnose endocarditis.
Major Criteria
Blood cultures positive for endocarditis
Evidence of endocarditis on echocardiogram
Minor Criteria
Fever
Predisposing heart condition or IV drug use
Vascular phenomena
Immunologic phenomena
Microbiological evidence not meeting major criteria above
Buzzword
Splinter Hemorrhage = Bacterial Endocarditis
NCLEX and USMLE Step Exams: High-yield practice notes and buzzword review for bacterial endocarditis
3. Birds Beak on Barium Swallow = Achalasia
A bird’s beak appearance on barium swallow is used to describe achalasia on exams.
Achalasia is the inability of the lower esophageal sphincter to relax.
The question stem will often describe a patient with difficulty swallowing (dysphagia) or pain with swallowing (odynophagia).
The patient may also have esophageal spasms causing chest pain that can mimic acute coronary syndrome (ACS) or a heart attack.
Achalasia is diagnosed using an esophagram or barium swallow.
Findings will demonstrate a birds beak pattern created by the contrast due to the open proximal esophagus coming to a point distally at the contracted lower esophageal sphincter.
Treatment can be nonsurgical using antispasmodics such as nifedipine/calcium channel blockers.
Surgical management may include balloon dilation, myomectomy, or botulinum injection.
Buzzword
Birds Beak on Barium Swallow = Achalasia
NCLEX and USMLE Step Exams: High-yield practice notes and buzzword review for achalasia
4. “Boot-Shaped” Heart = Tetralogy of Fallot
If a “boot-shaped heart” is used to describe the heart on a plain film or chest x-ray in a question stem, then you should think of tetralogy of Fallot.
Tetralogy of Fallot is the most common cyanotic congenital heart disease and is often tested on exams.
The tetrad for tetralogy of Fallot includes:
Ventricular septal defect (VSD)
Right ventricular outflow obstruction (pulmonic stenosis)
Overriding aorta
Right ventricular hypertrophy
Patients may have tet spells, which are acute episodes of cyanosis caused by right to left shunting through the VSD.
In order to recover from a tet spell, the patient will squat to increase afterload and decrease the shunting of deoxygenated blood to the left heart.
Buzzword
“Boot-Shaped” Heart = Tetralogy of Fallot
NCLEX and USMLE Step Exams: High-yield practice notes and buzzword review for tetralogy of Fallot
5. Palpable Olive Mass = Pyloric Stenosis
The buzzword for pyloric stenosis is palpable olive mass.
The opening between the stomach and the duodenum (first part of the small intestine) is known as the pylorus.
Pyloric stenosis is thickening or narrowing of the pylorus, which makes it difficult for food to pass.
A question stem involving an infant with projectile vomiting should make you consider pyloric stenosis as a possible diagnosis.
If the question stem describes feeling an “olive mass” on abdominal exam, then that is the clue for pyloric stenosis.
The “olive mass” is the enlarged/thickened pylorus.
Pyloric stenosis is more common in males and is typically seen before 12 weeks of age, although in some more rare cases can be seen from birth to 6 months.
Therefore, most question stems will usually have a male infant between 3-6 weeks old.
Diagnosis is made using ultrasound.
Treatment is surgical along with IV fluids and electrolyte replacement if necessary.
Buzzword
Palpable Olive Mass = Pyloric Stenosis
NCLEX and USMLE Step Exams: High-yield practice notes and buzzword review for pyloric stenosis
6. Snuffbox Tenderness = Scaphoid Fracture
If a question stem describes snuffbox tenderness on physical exam, you should think of a scaphoid fracture.
The snuffbox is the triangular depression at the base of the thumb on the dorsolateral aspect of the hand.
The scaphoid is one of the carpal bones in the wrist.
Scaphoid fractures may also cause pain with axial loading of the thumb on physical examination.
Scaphoid fractures commonly occur from a fall on outstretched hand (FOOSH).
Scaphoid fractures are the most common carpal bone fractures.
A possible complication of a scaphoid fracture is avascular necrosis, which is a decrease in blood flow to the bone which can cause the bone to die.
Diagnosis is made using X-ray.
Of note, there may be an occult fracture not seen on X-ray initially.
Therefore, if there is snuffbox tenderness or clinical concern for a scaphoid fracture, then treat it as such.
Treatment includes a thumb spica splint and appropriate follow up.
Buzzword
Snuffbox Tenderness = Scaphoid Fracture
NCLEX and USMLE Step Exams: High-yield practice notes and buzzword review for scaphoid fracture
7. Sudden Thunderclap Headache = Subarachnoid Hemorrhage
Thunderclap headache is a buzzword for subarachnoid hemorrhage, which is an intracranial bleed in the subarachnoid space typically caused by a ruptured cerebral aneurysm if non-traumatic.
The subarachnoid space is the space between the arachnoid mater and pia mater, which are 2 of the 3 meningeal layers that cover/surround the brain.
Another buzzword phrase for subarachnoid hemorrhage in a questions stem is “worst headache of their life”.
Diagnosis is typically made with a CT head, especially if obtained within 6 hours of symptom onset.
Treatment includes blood pressure control, anticoagulation reversal as necessary, and neurosurgical evaluation.
Buzzword
Thunderclap Headache = Subarachnoid Hemorrhage
NCLEX and USMLE Step Exams: High-yield practice notes and buzzword review for subarachnoid hemorrhage
8. Ascending Paralysis/Weakness = Guillain-Barre Syndrome
Ascending paralysis in a question stem is a buzzword for Guillain-Barre Syndrome (GBS).
GBS is a rare condition in which a person’s immune system attacks their own peripheral nervous system.
GBS is usually associated with a prodromal viral illness or recent diarrhea or foodborne illness (campylobacter).
The patient then develops acute onset, symmetric ascending paralysis.
GBS is mainly a disease of motor weakness and not much sensory deficit, although this can occur too.
Diagnosis involves clinical gestalt and lumbar puncture, which can show high protein and low white blood cell levels in the cerebrospinal fluid.
Treatment includes IVIG or plasmapheresis.
Buzzword
Symmetric Ascending Weakness = Guillain-Barre Syndrome
NCLEX and USMLE Step Exams: High-yield practice notes and buzzword review for Guillain-Barre syndrome
9. Cherry Red Spot = Central Retinal Artery Occlusion
A cherry red spot on funduscopic examination is a buzzword for central retinal artery occlusion (CRAO).
CRAO is the sudden blockage of the central retinal artery (branch of the ophthalmic artery).
Symptoms of CRAO include sudden painless monocular vision loss.
Causes include embolism, thrombus, temporal arteritis, sickle cell disease, and vasculitis.
Treatment includes ophthalmology consultation, decreased intraocular pressure (IOP), dislodgment of embolus, improvement of arterial flow, or consideration of steroids.
Of note, cherry red spot can also be seen in Tay-Sachs disease, however this is more rare and death usually occurs in infant/early childhood years. Symptoms include seizures, hearing loss, and inability to move.
Buzzword
Cherry Red Spot = Central Retinal Artery Occlusion
NCLEX and USMLE Step Exams: High-yield practice notes and buzzword review for central retinal artery occlusion (CRAO)
10. Thompson Test = Achilles Rupture
Question stems commonly describe a physical exam test and finding.
The question is assessing to see if you know what the test is and what it helps diagnose.
The purpose of the Thompson test is to assess for Achilles tendon rupture.
How is the Thompson test performed?
While the patient is lying prone, the examiner squeezes the patient’s calf muscles (gastrocnemius-soleus complex).
If the Achilles tendon is intact, then this will result in plantar flexion.
If there is a rupture of the Achilles tendon, then plantar flexion will not occur.
Buzzword
Thompson Test = Achilles Rupture
NCLEX and USMLE Step Exams: High-yield practice notes and buzzword review for Achilles rupture
Summary
Buzzwords and phrases allow you to quickly identify what the question is asking.
Question stems are often lengthy and spotting buzzwords can save you a lot of time on exams.
Creating a list of these and reading them every day can help you prepare for exams.
Apple Core Lesion = Colon Cancer
Splinter Hemorrhage = Bacterial Endocarditis
Bird’s Beak on Barium Swallow = Achalasia
Boot Shaped Heart = Tetralogy of Fallot
Palpable Olive Mass = Pyloric Stenosis
Snuffbox Tenderness = Scaphoid Fracture
Thunderclap Headache = Subarachnoid Hemorrhage
Ascending Paralysis/Weakness = Guillain-Barre Syndrome
Cherry Red Spot = Central Retinal Artery Occlusion
Thompson Test = Achilles Rupture
Check out other Buzzword Posts below!
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