AMC MCQ exam Prep by Dr Jayse

Purulent discharge from cervical os → Gonococcal/chlamydial cervicitis Vulvar vesicles + painful ulcers → Genital herpes Painless genital ulcer → Primary syphilis Painful grouped vesicles → HSV Painful genital ulcer + tender nodes → Chancroid Painless beefy-red ulcer → Granuloma inguinale Small painless ulcer + painful nodes → Lymphogranuloma venereum Vulvar burning + recurrent vesicles → HSV infection Genital ulcers + recurrent episodes → HSV Vulvar pruritus + obesity/diabetes + yeast → Candida Vaginal pH >4.5 + trichomonads → Trichomoniasis Vaginal pH >4.5 + clue cells → BV Vaginal pH normal + pseudohyphae → Candida Lack of inflammation + fishy discharge → BV Severe inflammation + frothy discharge → Trichomoniasis Atrophic pale vagina + elevated pH → Genitourinary syndrome of menopause Postmenopausal dryness + dyspareunia → Vulvovaginal atrophy Persistent itching + white vulvar plaque → Lichen sclerosus Thick leathery vulvar skin from scratching → Lichen simplex chronicus Vulvar erythema + eczematous lesion in older woman → Extramammary Paget disease Persistent vulvar lesion not responding to therapy → Biopsy Vulvar carcinoma risk + lichen sclerosus → Squamous cell carcinoma Heavy bleeding since menarche + easy bruising → von Willebrand disease Menorrhagia + normal pelvic exam + adolescent → Consider bleeding disorder Irregular heavy bleeding + anovulation → AUB-O Intermenstrual bleeding + focal intracavitary lesion → Endometrial polyp Saline infusion sonography + intracavitary mass → Endometrial polyp/submucosal fibroid Submucosal fibroid → Heavy menstrual bleeding Subserosal fibroid → Pressure/bulk symptoms Intramural fibroid → Enlarged irregular uterus Fibroid enlarging during pregnancy → Estrogen-responsive leiomyoma Fibroid after menopause should shrink → Leiomyoma Rapidly enlarging postmenopausal uterine mass → Leiomyosarcoma concern Leiomyosarcoma → Usually arises de novo, not from fibroid Endometrial biopsy needed in AUB age ≥45 → Rule out hyperplasia/cancer Younger woman + AUB + unopposed estrogen risk → Endometrial biopsy Endometrial thickness ≤4 mm in postmenopausal bleeding → Low cancer risk, if bleeding not persistent Persistent postmenopausal bleeding despite thin stripe → Endometrial sampling Obesity + PCOS + prolonged amenorrhea → Endometrial hyperplasia risk Atypical hyperplasia/EIN → High risk of endometrial carcinoma Type I endometrial cancer pattern → Estrogen-related endometrioid carcinoma Type II endometrial cancer pattern → Serous carcinoma, older/thin patient Psammoma bodies + papillary ovarian tumor → Serous ovarian carcinoma BRCA mutation + adnexal mass → High-grade serous ovarian carcinoma risk Adnexal mass + ascites + weight loss → Ovarian malignancy Young woman + ovarian mass + tumor marker clue → Think germ-cell tumor first

Postpartum hemorrhage + uterus not palpable abdominally → Uterine inversion Placenta previa + prior C-section → Placenta accreta spectrum Postpartum hemorrhage + failure to lactate → Sheehan syndrome Failure to lactate + amenorrhea after severe PPH → Sheehan syndrome Leakage with cough/sneeze → Stress urinary incontinence Urgency + leakage → Urge incontinence Constant dribbling + high postvoid residual → Overflow incontinence Continuous urine leakage through vagina → Vesicovaginal fistula Stool or gas through vagina → Rectovaginal fistula Anterior vaginal wall bulge → Cystocele Posterior vaginal wall bulge → Rectocele Uterus descending through introitus → Uterine prolapse DES exposure in utero → Clear-cell adenocarcinoma of vagina/cervix Genital warts → HPV 6,11 Cervical cancer → HPV 16,18 Bitemporal hemianopia + galactorrhea → Prolactinoma Deep dyspareunia + infertility → Endometriosis Dysmenorrhea + normal pelvic exam in young woman → Primary dysmenorrhea Progressive dysmenorrhea in older reproductive-age woman → Secondary dysmenorrhea Hot flashes + vaginal dryness → Menopause Heavy bleeding + normal-sized uterus + irregular cycles → Ovulatory dysfunction Infertility + prior PID → Tubal factor infertility Infertility + dysmenorrhea + dyspareunia → Endometriosis Amenorrhea + normal breasts + absent uterus → MRKH or AIS Absent uterus + testes → AIS Absent uterus + ovaries present → MRKH Rapid-onset hirsutism + deep voice → Androgen-secreting tumor Frothy discharge + strawberry cervix → Trichomoniasis Fishy odor + clue cells → BV Pruritus + cottage-cheese discharge → Candida Pelvic pain + CMT + fever → PID RUQ pain + violin-string adhesions → Fitz-Hugh–Curtis syndrome Postcoital bleeding + friable cervix → Cervical cancer until evaluated Postmenopausal bleeding + thickened endometrium → Endometrial pathology Snowstorm + no fetus → Complete mole Fetal tissue + triploidy → Partial mole No chorionic villi + very high β-hCG → Choriocarcinoma Ascites + pleural effusion + ovarian fibroma → Meigs syndrome Signet-ring cells in both ovaries → Krukenberg tumor Precocious puberty + Call-Exner bodies → Granulosa tumor AFP + Schiller-Duval → Yolk sac tumor LDH + fried-egg cells → Dysgerminoma Testosterone + virilization → Sertoli-Leydig tumor Hair + teeth + torsion risk → Mature teratoma Secondary amenorrhea + positive pregnancy test → Pregnancy until proven otherwise Amenorrhea + high prolactin + antipsychotic use → Drug-induced hyperprolactinemia High prolactin + hypothyroidism → TRH-mediated hyperprolactinemia Amenorrhea + low FSH + low estradiol → Hypothalamic/pituitary disorder Amenorrhea + high FSH + low estradiol → Primary ovarian failure Primary amenorrhea + uterus present + absent secondary sexual characteristics → Gonadal dysgenesis Primary amenorrhea + uterus absent + normal breasts → MRKH or AIS Primary amenorrhea + normal secondary sexual characteristics + obstruction → Imperforate hymen/transverse septum Primary amenorrhea + cyclic abdominal mass → Hematocolpos Hematocolpos → Imperforate hymen Amenorrhea after postpartum curettage → Asherman syndrome Infertility + recurrent miscarriage + intrauterine adhesions → Asherman syndrome Recurrent pregnancy loss + uterine septum → Müllerian anomaly Recurrent second-trimester loss + painless cervical dilation → Cervical insufficiency Short cervix on ultrasound → Cervical insufficiency risk Painless cervical dilation in 2nd trimester → Cervical insufficiency Infertility + bicornuate/ septate uterus → Müllerian anomaly Septate uterus → Highest miscarriage risk among common Müllerian anomalies Two uterine horns + heart-shaped fundus → Bicornuate uterus Two cervices + duplicated uterus → Uterus didelphys Unicornuate uterus → Single Müllerian duct development Pelvic pain + adnexal fullness + fever → Tubo-ovarian abscess PID + complex adnexal mass → Tubo-ovarian abscess PID + infertility → Tubal scarring PID + ectopic risk → Tubal damage Gonorrhea/chlamydia + ascending pelvic infection → PID Dysuria + discharge + cervical friability → Cervicitis

📝Gynecology 200 High-Yield Buzzwords & Signs 🔥🔥 Boggy uterus → Adenomyosis Irregular firm uterus → Leiomyoma Chocolate cyst → Endometriosis Powder-burn lesions → Endometriosis Fixed retroverted uterus → Endometriosis Tender uterosacral nodules → Endometriosis Strawberry cervix → Trichomoniasis Frothy yellow-green discharge → Trichomoniasis Clue cells → Bacterial vaginosis Fishy odor → Bacterial vaginosis Positive whiff test → Bacterial vaginosis Cottage-cheese discharge → Candida Pseudohyphae → Candida Mucopurulent cervix → Cervicitis Friable cervix → Cervicitis Chandelier sign → PID Cervical motion tenderness → PID Violin-string adhesions → Fitz-Hugh–Curtis syndrome RUQ pain + PID → Fitz-Hugh–Curtis syndrome Postcoital bleeding → Cervical pathology / cervical cancer Contact bleeding → Cervical cancer Koilocytes → HPV infection Cauliflower genital warts → Condyloma acuminatum Flat moist genital lesions → Condyloma lata Bluish bulging hymen → Imperforate hymen Primary amenorrhea + cyclic pelvic pain → Outflow obstruction D&C → amenorrhea → Asherman syndrome Absent uterus + absent/scant pubic hair → AIS Absent uterus + normal pubic hair → MRKH Primary amenorrhea + short stature + webbed neck → Turner syndrome Streak ovaries → Turner syndrome Amenorrhea + galactorrhea → Hyperprolactinemia Amenorrhea + weight loss/exercise/stress → Functional hypothalamic amenorrhea Amenorrhea + hot flashes + high FSH → Primary ovarian insufficiency Obesity + hirsutism + irregular menses → PCOS String of pearls ovaries → PCOS Rapid virilization → Androgen-secreting tumor Sudden unilateral pain + vomiting → Ovarian torsion Enlarged ovary + reduced Doppler flow → Ovarian torsion Midcycle unilateral pelvic pain → Mittelschmerz Positive β-hCG + unilateral pain → Ectopic pregnancy Positive β-hCG + empty uterus above discriminatory zone → Ectopic pregnancy Shoulder-tip pain + shock + pregnancy → Ruptured ectopic pregnancy Snowstorm appearance → Molar pregnancy Grape-like vesicles → Molar pregnancy Very high β-hCG + hyperthyroidism → Molar pregnancy Theca-lutein cysts → High β-hCG / molar pregnancy Persistent β-hCG after molar evacuation → Gestational trophoblastic neoplasia Very high β-hCG + lung metastases → Choriocarcinoma Call-Exner bodies → Granulosa cell tumor Coffee-bean nuclei → Granulosa cell tumor Estrogen-producing ovarian tumor → Granulosa cell tumor Precocious puberty + ovarian mass → Granulosa cell tumor Postmenopausal bleeding + ovarian mass → Granulosa cell tumor Schiller-Duval bodies → Yolk sac tumor Elevated AFP + ovarian mass → Yolk sac tumor Fried-egg cells → Dysgerminoma Elevated LDH + ovarian mass → Dysgerminoma Hair + teeth + sebum → Mature cystic teratoma Dermoid cyst → Mature cystic teratoma Virilization + ovarian mass → Sertoli-Leydig tumor Ovarian fibroma + ascites + pleural effusion → Meigs syndrome Bilateral ovarian masses + signet-ring cells → Krukenberg tumor Early satiety + bloating + adnexal mass → Ovarian cancer CA-125 elevation → Epithelial ovarian cancer marker Postmenopausal bleeding → Endometrial cancer must be excluded Unopposed estrogen → Endometrial hyperplasia/cancer Obesity + chronic anovulation → Endometrial hyperplasia Tamoxifen + bleeding → Endometrial pathology Thin elderly woman + aggressive endometrial cancer → Serous endometrial carcinoma Heavy menstrual bleeding + boggy uterus → Adenomyosis Heavy menstrual bleeding + irregular firm uterus → Leiomyoma Whorled uterine mass → Leiomyoma Painful heavy menses + diffuse uterine enlargement → Adenomyosis White parchment-like vulva → Lichen sclerosus Severe vulvar pruritus + thin white skin → Lichen sclerosus Persistent vulvar ulcer/mass → Vulvar cancer Painful unilateral Bartholin mass → Bartholin abscess New Bartholin mass in older woman → Consider malignancy Postpartum fever + uterine tenderness + foul lochia → Endometritis Cesarean delivery + postpartum fever → Endometritis Persistent postpartum fever despite antibiotics → Septic pelvic thrombophlebitis Postpartum hemorrhage + boggy uterus → Uterine atony

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MCQ ‼️ A 24-year-old patient with severe acute asthma has persistent bronchospasm despite repeated nebulized albuterol/ipratropium and IV corticosteroids. Which is the most appropriate next therapy? A. Magnesium oxide 400 mg PO B. Magnesium sulfate 2 g IV over 20 minutes C. Magnesium sulfate 2 g IV push over 1 minute D. Calcium gluconate 1 g IV over 10 minutes E. Observe

Internal branch → sensory above vocal cords Loss of laryngeal sensation → aspiration risk ⸻ Thyroid & ENT Surgical Anatomy Superior thyroid artery → close to external branch of superior laryngeal nerve Inferior thyroid artery → relationship with recurrent laryngeal nerve Thyroidectomy complication + hoarseness → RLN injury Thyroidectomy + inability to produce high-pitched sounds → external SLN injury ⸻ Ludwig Angina ⭐⭐⭐ Bilateral submandibular/sublingual infection → Ludwig angina Dental infection → floor-of-mouth cellulitis → Ludwig angina “Woody” induration of floor of mouth → Ludwig angina Tongue elevation → Ludwig angina Airway compromise → major danger Usually odontogenic → mandibular molar infection ⸻ Parotitis Painful parotid swelling + fever → parotitis Purulent drainage from Stensen duct → bacterial parotitis Stensen duct opens opposite upper second molar → parotid gland Dehydrated hospitalized patient → bacterial parotitis risk Mumps → bilateral parotitis + fever ⸻ Facial Nerve ⭐⭐⭐ CN VII → facial expression Bell palsy → LMN facial nerve palsy Entire ipsilateral face affected → Bell palsy Cannot wrinkle forehead + cannot close eye + drooping mouth → LMN CN VII lesion Forehead spared → UMN lesion/stroke Bell palsy treatment → corticosteroids ± antivirals depending on presentation Ramsay Hunt syndrome → vesicles in ear + ipsilateral facial paralysis Ramsay Hunt → VZV reactivation ⸻ Bell Palsy vs Stroke ⭐⭐⭐ Bell palsy: Forehead + eye closure + lower face all affected UMN stroke: Forehead relatively spared + contralateral lower facial weakness ⸻ Ramsay Hunt Syndrome Facial paralysis + painful vesicles around ear → Ramsay Hunt Varicella-zoster virus → Ramsay Hunt Geniculate ganglion involvement → Ramsay Hunt Can cause hearing loss/tinnitus/vertigo → Ramsay Hunt ⸻ Parotid Tumors Most common benign salivary gland tumor → pleomorphic adenoma Painless slow-growing parotid mass → pleomorphic adenoma Facial nerve weakness + parotid mass → malignant salivary gland tumor Facial nerve involvement in parotid mass → concerning for malignancy 🔥 20 Ultra-HY ENT Buzzwords Bulging TM → Acute otitis media Pain with tragal movement → Otitis externa Foul-smelling otorrhea + white keratin → Cholesteatoma 4-kHz notch → Noise-induced hearing loss Carhart notch → Otosclerosis Weber → affected ear → Conductive hearing loss Weber → unaffected ear → Sensorineural hearing loss Vertigo + tinnitus + fluctuating hearing loss → Ménière disease Positional vertigo + positive Dix-Hallpike → BPPV Unilateral SNHL → Vestibular schwannoma Bilateral vestibular schwannomas → NF2 Aspirin + asthma + nasal polyps → AERD Hot potato voice + uvular deviation → Peritonsillar abscess Drooling + tripod + thumbprint → Epiglottitis Barking cough + steeple sign → Croup Foul unilateral nasal discharge in child → Foreign body Hoarseness after thyroidectomy → Recurrent laryngeal nerve injury Cannot produce high-pitched sounds → External superior laryngeal nerve injury Woody floor of mouth + dental infection → Ludwig angina Facial paralysis + ear vesicles → Ramsay Hunt syndrome #usmleprep #USMLEStep2CK #usmlestep1 #ent

Nasal obstruction + facial pressure + nasal discharge → chronic sinusitis Nasal polyps → chronic rhinosinusitis association ⸻ Nasal Polyps ⭐ Pale, translucent, boggy nasal masses → nasal polyps Usually painless → nasal polyps Bilateral nasal obstruction → nasal polyps Associated with asthma → nasal polyps Aspirin sensitivity + asthma + nasal polyps → AERD/Samter triad Nasal polyps + cystic fibrosis → classic association Treatment → intranasal corticosteroids ⸻ AERD / Samter Triad ⭐⭐⭐ Asthma + nasal polyps + aspirin/NSAID sensitivity → AERD NSAID ingestion → bronchospasm → AERD COX-1 inhibition → ↓ prostaglandins + ↑ leukotrienes Avoid nonselective NSAIDs → AERD ⸻ Adenoid Hypertrophy Child + chronic nasal obstruction → adenoid hypertrophy Mouth breathing → adenoid hypertrophy “Adenoid facies” → chronic adenoid hypertrophy Hyponasal speech → adenoid hypertrophy Snoring/OSA in child → adenoid/tonsillar hypertrophy Eustachian tube dysfunction/recurrent otitis media → enlarged adenoids ⸻ Tonsillitis / Peritonsillar Abscess ⭐⭐⭐ Fever + sore throat + tonsillar exudates → tonsillitis Group A strep → Streptococcus pyogenes Palatal petechiae → GAS pharyngitis Tender anterior cervical lymphadenopathy → GAS Cough + rhinorrhea → viral rather than GAS Peritonsillar abscess “Hot potato” muffled voice → peritonsillar abscess Unilateral tonsillar swelling → peritonsillar abscess Uvula deviates AWAY from affected side → peritonsillar abscess ⭐ Trismus → peritonsillar abscess Drooling → peritonsillar abscess Treatment → drainage + antibiotics ⸻ Retropharyngeal Abscess ⭐ Young child + fever + neck stiffness → retropharyngeal abscess Drooling + dysphagia → retropharyngeal abscess Neck swelling/stiffness → retropharyngeal abscess Recent URI → possible precipitating infection Posterior pharyngeal bulging → retropharyngeal abscess Can cause airway obstruction → emergency ⸻ Epiglottitis ⭐⭐⭐ Child + high fever + drooling + respiratory distress → epiglottitis Tripod position → epiglottitis Muffled voice → epiglottitis Stridor → epiglottitis “Thumbprint sign” on lateral neck X-ray → epiglottitis Do NOT aggressively examine the throat → risk of airway obstruction Airway first → epiglottitis Historically Hib → classic USMLE association Unvaccinated child → think Hib ⸻ Croup ⭐⭐⭐ Barking cough → croup Seal-like barking cough → croup Inspiratory stridor → croup Steeple sign → croup Usually viral → parainfluenza Usually age 6 months–3 years → croup Treatment: dexamethasone → croup Moderate/severe disease → nebulized epinephrine Croup vs Epiglottitis Barking cough → Croup Drooling + tripod + toxic appearance → Epiglottitis ⸻ Foreign Body Sudden unilateral foul-smelling nasal discharge in child → nasal foreign body Unilateral purulent rhinorrhea → nasal foreign body Sudden coughing/choking episode → airway foreign body Unilateral decreased breath sounds → bronchial foreign body Most common site of aspiration → right main bronchus ⸻ Laryngeal Cancer ⭐ Persistent hoarseness >2–3 weeks → evaluate for laryngeal malignancy Smoking + hoarseness → laryngeal squamous cell carcinoma Alcohol + smoking → increased risk Supraglottic tumor → dysphagia/odynophagia Glottic tumor → early hoarseness Persistent unilateral otalgia with normal ear exam → referred pain from head/neck malignancy ⸻ Vocal Cord Paralysis Hoarseness after thyroid surgery → recurrent laryngeal nerve injury Unilateral recurrent laryngeal nerve damage → hoarseness Bilateral recurrent laryngeal nerve injury → airway obstruction/stridor Left recurrent laryngeal nerve travels under aortic arch → thoracic lesions can cause hoarseness Left vocal cord paralysis + mediastinal mass → recurrent laryngeal nerve compression ⸻ Recurrent Laryngeal Nerve Motor innervation of most intrinsic laryngeal muscles → recurrent laryngeal nerve Exception = cricothyroid → external branch of superior laryngeal nerve RLN injury → hoarseness Bilateral RLN injury → airway compromise ⸻ Superior Laryngeal Nerve External branch → motor to cricothyroid Cricothyroid → tenses vocal cords External SLN injury → weak/high-pitched voice

Sensorineural hearing loss → presbycusis Bilateral symmetric → presbycusis ⸻ Noise-Induced Hearing Loss Chronic loud-noise exposure → SNHL 4-kHz notch on audiogram → noise-induced hearing loss ⭐ Concert worker / factory worker / firearm exposure → noise-induced SNHL Usually bilateral → occupational noise exposure ⸻ Vestibular Schwannoma ⭐⭐⭐ Unilateral sensorineural hearing loss → vestibular schwannoma Unilateral tinnitus → vestibular schwannoma Balance problems + unilateral hearing loss → vestibular schwannoma CN VIII tumor → vestibular schwannoma Cerebellopontine angle mass → vestibular schwannoma Bilateral vestibular schwannomas → NF2 NF2 + bilateral CN VIII tumors → classic association MRI with gadolinium → diagnostic imaging ⸻ Ménière Disease ⭐⭐⭐ Episodic vertigo + hearing loss + tinnitus → Ménière disease Fluctuating sensorineural hearing loss → Ménière Aural fullness → Ménière Endolymphatic hydrops → underlying mechanism Low-frequency hearing loss initially → Ménière Episodes last minutes to hours → Ménière No focal neurologic deficits → supports peripheral vertigo Buzzword triad: Vertigo + tinnitus + fluctuating hearing loss ⸻ BPPV ⭐⭐⭐ Brief episodes of vertigo triggered by head movement → BPPV Rolling over in bed → vertigo → BPPV Looking up → vertigo → BPPV Positive Dix-Hallpike → BPPV Nystagmus with positional testing → BPPV Most commonly posterior semicircular canal → BPPV No hearing loss → BPPV Treatment → Epley/canalith repositioning maneuver Key distinction: BPPV = positional + seconds + NO hearing loss ⸻ Vestibular Neuronitis Acute prolonged vertigo after viral illness → vestibular neuritis Vertigo lasting days → vestibular neuritis No hearing loss → vestibular neuritis No tinnitus → vestibular neuritis Peripheral vestibular disorder → vestibular neuritis Labyrinthitis Vertigo + hearing loss after viral infection → labyrinthitis Vestibular neuritis + hearing loss → think labyrinthitis ⸻ Central vs Peripheral Vertigo Peripheral Severe vertigo → peripheral Nausea/vomiting → peripheral Unidirectional horizontal nystagmus → peripheral Nystagmus suppressed by visual fixation → peripheral Hearing symptoms may occur → peripheral Central Vertical nystagmus → central Direction-changing nystagmus → central Neurologic deficits → central Severe gait ataxia → central Nystagmus not suppressed by visual fixation → central Cerebellar stroke → central vertigo ⸻ Eustachian Tube Dysfunction Ear fullness after URI/flight → eustachian tube dysfunction Retracted TM → eustachian tube dysfunction Barotrauma during airplane descent → eustachian tube dysfunction Difficulty equalizing pressure → eustachian tube dysfunction ⸻ Epistaxis ⭐ Most common site of anterior epistaxis → Kiesselbach plexus Children + nose picking → anterior epistaxis Visible bleeding vessel on anterior septum → Kiesselbach Most common overall epistaxis → anterior Posterior epistaxis → older adults, hypertension/atherosclerosis Posterior bleeding → sphenopalatine artery Blood flowing into posterior pharynx → posterior epistaxis Posterior epistaxis often requires packing/ENT intervention Management First step → sit forward + pinch soft nose Topical vasoconstrictor → oxymetazoline Persistent visible anterior bleeding → cautery Uncontrolled posterior bleeding → posterior packing + ENT ⸻ Nasal Fracture Most common facial fracture → nasal fracture Nasal trauma + deformity → nasal fracture Septal hematoma → emergency Fluctuant swelling of nasal septum → septal hematoma Untreated septal hematoma → cartilage necrosis → saddle-nose deformity Septal hematoma requires drainage → urgent ENT management ⸻ Sinusitis ⭐ Acute bacterial rhinosinusitis Symptoms >10 days without improvement → bacterial sinusitis Severe fever + purulent nasal discharge ≥3 days → bacterial sinusitis “Double worsening” → bacterial sinusitis Initial viral URI improves then worsens → bacterial sinusitis Common organisms → S. pneumoniae, H. influenzae First-line treatment when antibiotics indicated → amoxicillin-clavulanate Chronic sinusitis Symptoms ≥12 weeks → chronic rhinosinusitis

👂 Whole ENT amc Buzzwords in one post 🔥 Otitis Media Acute otitis media (AOM) → bulging, erythematous tympanic membrane + middle-ear effusion Ear pain + fever + recent URI → AOM Pneumatic otoscopy: decreased TM mobility → middle-ear effusion Most common organism in children → Streptococcus pneumoniae Other AOM organisms → H. influenzae, Moraxella catarrhalis AOM after viral URI → bacterial superinfection Antibiotic first-line → amoxicillin Amoxicillin recently used / conjunctivitis → amoxicillin-clavulanate → β-lactamase-producing H influenzae AOM + otorrhea through tympanostomy tube → topical fluoroquinolone ear drops Otitis media with effusion “Glue ear” → otitis media with effusion Fluid behind TM without acute inflammation → OME Conductive hearing loss after URI → OME Usually no fever or significant ear pain → OME Persistent unilateral middle-ear effusion in adult → evaluate for nasopharyngeal mass Children + recurrent OME + speech delay → hearing evaluation ± tympanostomy tubes ⸻ Otitis Externa “Swimmer’s ear” → acute otitis externa Pain with tragal manipulation → otitis externa Pain when pulling pinna → otitis externa Ear canal edema + erythema → otitis externa Most common organism → Pseudomonas aeruginosa Treatment → topical antibiotic ear drops Tympanic membrane perforation/tube present → use non-ototoxic fluoroquinolone drops Avoid aminoglycoside-containing drops if TM perforation → risk of ototoxicity Malignant otitis externa Older patient + diabetes + severe otalgia → malignant otitis externa Severe pain out of proportion → malignant otitis externa Granulation tissue in external auditory canal → malignant otitis externa Cranial nerve palsy → advanced malignant otitis externa Typical organism → Pseudomonas Treatment → systemic antipseudomonal antibiotics ⸻ Tympanic Membrane Dull, bulging TM → AOM Retracted TM → eustachian tube dysfunction Air-fluid level/bubbles behind TM → middle-ear effusion Perforated TM + purulent drainage → otitis media with perforation Central TM perforation → usually chronic otitis media Attic/marginal perforation + foul-smelling discharge → cholesteatoma ⸻ Cholesteatoma ⭐ Painless chronic otorrhea → cholesteatoma Foul-smelling ear discharge → cholesteatoma White keratin debris behind TM → cholesteatoma Retraction pocket containing keratin → cholesteatoma Conductive hearing loss + chronic ear disease → cholesteatoma Erosion of ossicles → cholesteatoma Can erode bone → cholesteatoma Treatment → surgical removal Classic clue: Foul-smelling otorrhea + conductive hearing loss + white mass ⸻ Hearing Loss Conductive External/middle ear problem → conductive hearing loss Otosclerosis → conductive hearing loss Cerumen impaction → conductive hearing loss Otitis media → conductive hearing loss Tympanic membrane perforation → conductive hearing loss Ossicular damage → conductive hearing loss Sensorineural Cochlea/CN VIII problem → sensorineural hearing loss Presbycusis → bilateral high-frequency sensorineural hearing loss Noise exposure → high-frequency SNHL Ototoxic drugs → SNHL Vestibular schwannoma → unilateral SNHL ⸻ Rinne & Weber ⭐⭐⭐ Rinne Normal → air conduction > bone conduction Conductive hearing loss → bone conduction > air conduction Sensorineural hearing loss → air conduction > bone conduction Weber Conductive hearing loss → sound lateralizes to affected ear Sensorineural hearing loss → sound lateralizes to unaffected ear Easy rule: Conductive → Weber goes toward the bad ear Sensorineural → Weber goes toward the good ear ⸻ Otosclerosis ⭐⭐⭐ Young/middle-aged adult + progressive hearing loss → otosclerosis Usually conductive hearing loss → otosclerosis Stapes fixation → otosclerosis Normal TM + progressive conductive hearing loss → otosclerosis Pregnancy may worsen symptoms → otosclerosis Carhart notch at 2 kHz → otosclerosis Treatment → hearing aid or stapedectomy/stapedotomy ⸻ Presbycusis Elderly patient + gradual bilateral hearing loss → presbycusis High-frequency hearing loss → presbycusis Difficulty understanding speech, especially in noisy environments → presbycusis

Autosomal dominant usually Mucocutaneous bleeding Epistaxis Menorrhagia Easy bruising ↓ platelet adhesion May cause ↑ PTT because vWF stabilizes factor VIII Treatment → desmopressin Buzzword: “Mucosal bleeding + normal platelets + desmopressin” ⸻ Bernard-Soulier Syndrome Defective GpIb Cannot bind vWF Giant platelets Thrombocytopenia ↑ bleeding time Remember: Bernard-Soulier = GpIb ⸻ Glanzmann Thrombasthenia Defective GpIIb/IIIa Cannot bind fibrinogen Impaired platelet aggregation Normal platelet count ↑ bleeding time Remember: Glanzmann = GpIIb/IIIa ⸻ ⚡ Ultra-High-Yield “Instant Diagnosis” Lines Auer rods → AML Auer rods + DIC → APL t(9;22) → CML Smudge cells → CLL Reed-Sternberg → Hodgkin t(14;18) → Follicular lymphoma t(8;14) → Burkitt t(11;14) → Mantle cell CRAB → Multiple myeloma IgM + hyperviscosity → Waldenström Spherocytes → hereditary spherocytosis / warm AIHA Heinz bodies + bite cells → G6PD Sickle cells → sickle cell disease Schistocytes + thrombocytopenia → TTP/HUS/DIC Bloody diarrhea + AKI → HUS Neurologic symptoms + MAHA → TTP ↑ PT + ↑ PTT + ↓ fibrinogen → DIC Hemarthrosis + ↑ PTT → Hemophilia Mucosal bleeding + vWF problem → vWD GpIb → Bernard-Soulier GpIIb/IIIa → Glanzmann Pancytopenia + hypocellular marrow → aplastic anemia Microcytosis + low ferritin → iron deficiency Microcytosis + high RBC count → thalassemia Low iron + low TIBC + high ferritin → anemia of chronic disease

Acute Myeloid Leukemia — AML Auer rods Myeloperoxidase positive Myeloblasts Older adults t(15;17) → acute promyelocytic leukemia PML-RARA Severe DIC Treatment → ATRA APL is a hematologic emergency Buzzword: “Auer rods + DIC → APL → ATRA” ⸻ ALL Most common leukemia in children TdT positive B-cell or T-cell lineage Bone pain Fever Hepatosplenomegaly CNS involvement t(12;21) → favorable B-ALL t(9;22) → worse prognosis T-ALL Adolescent male Mediastinal mass Thymic origin Buzzword: “Child + lymphoblasts + TdT” ⸻ CML t(9;22) Philadelphia chromosome BCR-ABL Constitutively active tyrosine kinase Very high WBC Basophilia Splenomegaly Low leukocyte alkaline phosphatase Treatment → imatinib Buzzword: “Massive leukocytosis + basophilia + splenomegaly → CML” ⸻ CLL Most common leukemia in older adults Smudge cells CD5+ CD23+ B-cell malignancy Hypogammaglobulinemia Recurrent infections Autoimmune hemolytic anemia Can transform into aggressive lymphoma → Richter transformation Buzzword: “Older adult + lymphocytosis + smudge cells” ⸻ 🧫 Lymphomas Hodgkin Lymphoma Reed-Sternberg cells CD15+ CD30+ Painless lymphadenopathy B symptoms Fever Night sweats Weight loss Alcohol-induced lymph node pain Contiguous spread Often cervical lymph nodes Buzzword: “Reed-Sternberg + CD15/CD30” ⸻ Non-Hodgkin Lymphoma Usually noncontiguous spread Extranodal involvement common Multiple subtypes Can involve GI tract, skin, CNS, bone marrow ⸻ Follicular Lymphoma t(14;18) BCL2 overexpression Indolent Painless lymphadenopathy “Back-to-back” follicles Buzzword: “t(14;18) → BCL2 → follicular lymphoma” ⸻ Burkitt Lymphoma Extremely rapid growth t(8;14) MYC activation “Starry-sky” appearance African endemic → jaw mass Sporadic → abdominal mass Tumor lysis syndrome risk Buzzword: “Fast-growing + starry sky + t(8;14)” ⸻ Mantle Cell Lymphoma t(11;14) Cyclin D1 ↑ CD5+ Older adults GI involvement Multiple lymphomatous polyposis Buzzword: “CD5+ lymphoma + cyclin D1 + t(11;14)” ⸻ Multiple Myeloma Older adult CRAB Calcium ↑ Renal dysfunction Anemia Bone lesions Lytic bone lesions “Punched-out” lesions Monoclonal IgG Rouleaux formation M-spike Bence Jones proteins β2-microglobulin → prognosis Bone marrow → plasma cells Recurrent infections Buzzword: “CRAB + punched-out lesions + M-spike” ⸻ MGUS Monoclonal protein ❤ g/dL Bone marrow plasma cells <10% No CRAB features Precursor to multiple myeloma ⸻ Waldenström Macroglobulinemia IgM Lymphoplasmacytic lymphoma Hyperviscosity Headache Blurred vision Neurologic symptoms No lytic bone lesions No hypercalcemia typically Buzzword: “IgM + hyperviscosity + no lytic lesions” ⸻ 🩸 Platelet Disorders ITP Isolated thrombocytopenia Petechiae/purpura Normal PT/PTT Large/young platelets Autoimmune destruction Children → often after viral infection Adults → chronic Associated with HIV/SLE Treatment → steroids ± IVIG Buzzword: “Isolated low platelets + normal PT/PTT” ⸻ TTP Think MAHA + thrombocytopenia + neurologic/renal findings Thrombocytopenia Renal dysfunction Anemia/MAHA Fever Neurologic symptoms Schistocytes ↓ ADAMTS13 Usually normal PT/PTT Treatment → plasma exchange immediately Buzzword: “Schistocytes + thrombocytopenia + neurologic symptoms → TTP” ⸻ HUS MAHA Thrombocytopenia Acute kidney injury Often follows bloody diarrhea Shiga toxin → EHEC Children Normal PT/PTT Treatment usually supportive Buzzword: “Bloody diarrhea → AKI + thrombocytopenia + schistocytes” ⸻ DIC Consumption of clotting factors + platelets Bleeding and thrombosis ↑ PT ↑ PTT ↑ D-dimer ↓ fibrinogen ↓ platelets Schistocytes Causes: Sepsis Trauma Obstetric complications Malignancy APL Buzzword: “Bleeding + prolonged PT/PTT + low fibrinogen + high D-dimer” ⸻ Hemophilia A Factor VIII deficiency X-linked recessive Hemarthroses Deep tissue bleeding ↑ PTT Normal PT Normal bleeding time Treatment → factor VIII Desmopressin can help mild disease Buzzword: “Male + hemarthroses + isolated ↑ PTT” ⸻ Hemophilia B Factor IX deficiency X-linked Clinically similar to hemophilia A Christmas disease ⸻ von Willebrand Disease Most common inherited bleeding disorder

🩸 Whole HY Hematology in one post 🔥✅ Iron Deficiency Anemia Microcytic, hypochromic anemia ↓ Ferritin = most specific clue ↓ Serum iron ↑ TIBC ↑ RDW Pica → especially ice (pagophagia) Koilonychia → spoon-shaped nails Chronic blood loss → think GI bleeding Premenopausal woman → menstrual blood loss Most common cause in adult men/postmenopausal women → GI blood loss until proven otherwise ⸻ Anemia of Chronic Disease Usually normocytic, sometimes microcytic ↓ Serum iron ↓ TIBC ↑/normal ferritin ↑ Hepcidin Chronic infection, inflammation, malignancy Iron trapped inside macrophages Think: “Iron is there, but unavailable.” ⸻ Thalassemia Severe microcytosis out of proportion to anemia ↑ RBC count despite anemia Normal/↑ ferritin Target cells Basophilic stippling may occur β-thalassemia major: severe anemia beginning in infancy “Chipmunk facies” “Crew-cut” skull Hepatosplenomegaly Transfusion dependence β-thalassemia minor: mild anemia, often asymptomatic Hb electrophoresis: ↑ HbA₂ → β-thalassemia trait α-thalassemia → HbH / Hb Bart’s ⸻ 🧬 Hemolytic Anemias General Hemolysis Think: ↑ LDH + ↑ indirect bilirubin + ↓ haptoglobin + ↑ reticulocytes Jaundice Splenomegaly Dark urine may occur Extravascular hemolysis Spleen/macrophages ↑ indirect bilirubin Splenomegaly Spherocytes Intravascular hemolysis RBC destruction inside blood vessels Hemoglobinuria ↓↓↓ haptoglobin Hemosiderinuria ↑ LDH ⸻ Hereditary Spherocytosis Spherocytes ↑ MCHC Extravascular hemolysis Splenomegaly Autosomal dominant Defect in RBC membrane proteins Ankyrin/spectrin/band 3 Positive family history Eosin-5-maleimide binding ↓ Splenectomy → definitive treatment in severe disease Pigment gallstones Buzzword: “Spherocytes + increased MCHC + family history” ⸻ G6PD Deficiency Episodic hemolysis Oxidative stress triggers: Sulfonamides Dapsone Primaquine Nitrofurantoin Fava beans Infection Heinz bodies Bite cells X-linked recessive African/Mediterranean ancestry can be a clue G6PD protects RBCs by generating NADPH ↓ glutathione → oxidative damage Buzzword: “Fava beans/drug + hemolysis + bite cells/Heinz bodies” ⸻ Sickle Cell Disease HbS β-globin mutation: Glu → Val Autosomal recessive Vaso-occlusive crises Severe pain Acute chest syndrome Dactylitis Autosplenectomy Increased risk of encapsulated bacteria Salmonella osteomyelitis Pigment gallstones Aplastic crisis → Parvovirus B19 Howell-Jolly bodies Hydroxyurea → ↑ HbF Pain crisis → hydration + analgesia Acute chest → oxygen + antibiotics + analgesia ± transfusion Classic triggers Dehydration Infection Hypoxia Acidosis Buzzword: “Pain + autosplenectomy + Howell-Jolly bodies” ⸻ Sickle Cell Trait Usually asymptomatic Hematuria Renal papillary necrosis Splenic infarction at high altitude Usually does not cause severe vaso-occlusive disease ⸻ Pyruvate Kinase Deficiency ↓ ATP production Hemolytic anemia Echinocytes/burr cells ↑ 2,3-BPG Autosomal recessive Splenomegaly Chronic hemolysis Buzzword: “Hemolysis + echinocytes + ↑ 2,3-BPG” ⸻ Autoimmune Hemolytic Anemia Warm AIHA IgG Extravascular hemolysis Spherocytes Positive direct Coombs Associated with: SLE CLL Methyldopa Treatment → glucocorticoids Buzzword: “IgG + 37°C + spherocytes” Cold AIHA IgM Complement-mediated Agglutination Associated with: Mycoplasma pneumoniae EBV Symptoms worse with cold Treat underlying disease ± rituximab Buzzword: “Cold exposure + IgM + RBC agglutination” ⸻ PNH — Paroxysmal Nocturnal Hemoglobinuria Intravascular hemolysis Hemoglobinuria Thrombosis Abdominal pain Pancytopenia PIGA mutation Defective GPI anchor ↓ CD55 and CD59 Complement-mediated RBC destruction Treatment → eculizumab/ravulizumab Buzzword: “Hemolysis + thrombosis in unusual sites + pancytopenia” ⸻ 🩸 Bone Marrow Disorders Aplastic Anemia Pancytopenia Hypocellular bone marrow Few/no hematopoietic cells No splenomegaly Causes: Benzene Radiation Drugs Viral infections Autoimmune Parvovirus B19 usually causes pure red cell aplasia, not classic aplastic anemia Treatment → stem-cell transplant in appropriate young patients Buzzword: “Pancytopenia + empty/hypocellular marrow” ⸻

Triceps → elbow extension Musculocutaneous → anterior arm Radial → posterior arm/forearm Median → most anterior forearm Ulnar → most intrinsic hand muscles FDS → PIP flexion FDP → DIP flexion PAD/DAB → ulnar nerve Gluteus maximus → hip extension Gluteus medius → hip abduction Superior gluteal nerve → Trendelenburg Quadriceps → knee extension → femoral nerve Hamstrings → knee flexion → sciatic nerve Anterior leg → dorsiflexion → deep fibular Lateral leg → eversion → superficial fibular Posterior leg → plantarflexion → tibial

If left side of pelvis drops → right gluteus medius/minimus weakness → right superior gluteal nerve lesion. Gluteus minimus Hip abduction + medial rotation Superior gluteal nerve. TENSOR FASCIAE LATAE Hip abduction + medial rotation Tightens iliotibial tract Nerve → superior gluteal nerve. HIP FLEXORS Iliopsoas Main hip flexor Psoas major + iliacus Nerve → femoral nerve + direct branches of lumbar plexus Sartorius Flexes hip Abducts hip Laterally rotates hip Flexes knee Nerve → femoral nerve. Mnemonic: Tailor’s muscle → sartorius. THIGH — ANTERIOR COMPARTMENT Main nerve → Femoral nerve Quadriceps Rectus femoris Knee extension Hip flexion Vastus lateralis Knee extension Vastus medialis Knee extension Helps stabilize patella. Vastus intermedius Knee extension All: → Femoral nerve → L2–L4. THIGH — MEDIAL COMPARTMENT Main action → hip adduction Main nerve → Obturator nerve Adductor longus → adduction Adductor brevis → adduction Adductor magnus Adduction Hamstring portion → hip extension Gracilis Hip adduction Knee flexion Medial rotation of leg Obturator nerve. THIGH — POSTERIOR COMPARTMENT Main nerve → Sciatic nerve Hamstrings Semitendinosus Hip extension Knee flexion Medial rotation Semimembranosus Hip extension Knee flexion Medial rotation Biceps femoris Hip extension Knee flexion Lateral rotation Nerve Semitendinosus → tibial division of sciatic Semimembranosus → tibial division Biceps femoris long head → tibial division Biceps femoris short head → common fibular division LEG — ANTERIOR COMPARTMENT Main nerve → Deep fibular nerve Main action → dorsiflexion Tibialis anterior Dorsiflexion Inversion Deep fibular nerve Extensor hallucis longus Extension of great toe Dorsiflexion Extensor digitorum longus Extension of toes Dorsiflexion Deep fibular nerve injury → foot drop LEG — LATERAL COMPARTMENT Main nerve → Superficial fibular nerve Main action → eversion Fibularis longus → eversion Fibularis brevis → eversion Superficial fibular nerve injury → weak eversion. LEG — POSTERIOR COMPARTMENT Main nerve → Tibial nerve Main action → plantarflexion Gastrocnemius Plantarflexion Knee flexion Soleus Plantarflexion Important postural muscle. Plantaris Weak plantarflexion + knee flexion. Tibialis posterior Plantarflexion Inversion ACHILLES TENDON Gastrocnemius + soleus → Achilles tendon. Achilles reflex: → S1–S2 → tibial nerve. Achilles rupture → difficulty plantarflexing. FOOT INVERSION vs EVERSION Inversion Tibialis anterior + Tibialis posterior Eversion Fibularis longus + Fibularis brevis Easy memory: TA + TP = inversion FL + FB = eversion NECK MUSCLES Sternocleidomastoid Unilateral → rotates face to opposite side Lateral flexion to same side Bilateral → neck flexion Nerve → CN XI Sensory/proprioceptive contribution → C2–C3. CN XI injury → difficulty turning head against resistance → shoulder droop due to trapezius weakness. TRAPEZIUS Elevates scapula → upper fibers Retracts scapula → middle fibers Depresses scapula → lower fibers Upward rotation → upper + lower fibers Nerve → CN XI Clinical CN XI injury → difficulty shrugging shoulder. SERRATUS ANTERIOR Protracts scapula Upward rotation of scapula Keeps scapula against thoracic wall Nerve → long thoracic nerve Roots → C5–C7 Injury → winged scapula Classic cause: axillary lymph node surgery / trauma RHOMBOIDS Scapular retraction Downward rotation Nerve → dorsal scapular nerve Root → C5. DIAPHRAGM Main muscle of inspiration Nerve → phrenic nerve Roots → C3–C5 Mnemonic: C3, 4, 5 keep the diaphragm alive. Phrenic nerve injury → ipsilateral diaphragmatic paralysis. EXTRAOCULAR MUSCLES LR6 SO4, 3 all the rest Lateral rectus → CN VI Superior oblique → CN IV All others → CN III Superior rectus → elevation + medial rotation + adduction Inferior rectus → depression + lateral rotation + adduction Superior oblique → depression + medial rotation + abduction Inferior oblique → elevation + lateral rotation + abduction. 20 MUSCLE FACTS TO MEMORIZE FOR USMLE Supraspinatus → initiates abduction Deltoid → abducts 15–90° Axillary nerve → surgical neck of humerus Biceps → supination

💪 HIGH-YIELD MUSCLES TESTED IN EVERY MEDICAL EXAMS 💯🔥 ROTATOR CUFF-> SITS Supraspinatus Action → initiates abduction (0–15°) Nerve → Suprascapular nerve Root → C5–C6 Injury → difficulty initiating shoulder abduction Most commonly injured rotator cuff tendon. Infraspinatus Action → external/lateral rotation Nerve → Suprascapular nerve Root → C5–C6 Teres minor Action → external rotation Nerve → Axillary nerve Root → C5–C6 Subscapularis Action → internal/medial rotation Nerve → Upper and lower subscapular nerves Root → C5–C7 Classic question Cannot initiate abduction → supraspinatus/suprascapular nerve. Cannot abduct arm from 15–90° → deltoid/axillary nerve. DELTOID Action → abduction 15–90° Nerve → Axillary nerve Roots → C5–C6 Axillary nerve injury → loss of shoulder abduction Associated fracture → surgical neck of humerus Sensory loss → regimental badge area Sequence of abduction 0–15° → supraspinatus 15–90° → deltoid

90° → trapezius + serratus anterior

BICEPS BRACHII Action → elbow flexion Strongest action → forearm supination Nerve → Musculocutaneous nerve Roots → C5–C6 Long head → originates from supraglenoid tubercle Short head → originates from coracoid process Clinical Musculocutaneous nerve injury → weak elbow flexion + weak supination → sensory loss over lateral forearm. BRACHIALIS Main action → elbow flexion Nerve → Musculocutaneous nerve Root → C5–C6 It is the primary flexor of the elbow regardless of forearm position. TRICEPS ⭐⭐⭐ Action → elbow extension Nerve → Radial nerve Roots → C6–C8 Long head → originates from infraglenoid tubercle. Classic Radial nerve lesion → weak elbow/wrist/finger extension. CORACOBRACHIALIS Action → shoulder flexion + adduction Nerve → Musculocutaneous nerve Root → C5–C7 Musculocutaneous nerve pierces coracobrachialis. FOREARM — ANTERIOR COMPARTMENT Superficial muscles Pronator teres Action → pronation Nerve → Median nerve Roots → C6–C7 Flexor carpi radialis Action → wrist flexion + abduction Nerve → median nerve Palmaris longus Action → wrist flexion Nerve → median nerve Frequently absent. Useful clinically for tendon grafting. Flexor carpi ulnaris Action → wrist flexion + adduction Nerve → ulnar nerve Roots → C8–T1 ANTERIOR FOREARM Flexor digitorum profundus Flexes DIP joints Lateral half → median nerve / anterior interosseous nerve Medial half → ulnar nerve Classic USMLE Cannot flex DIP of index/middle finger → anterior interosseous nerve lesion. Cannot flex DIP of ring/little finger → ulnar nerve lesion. Flexor digitorum superficialis Flexes PIP joints Nerve → median nerve. Remember: FDS → PIP FDP → DIP Flexor pollicis longus Flexes thumb IP joint Nerve → anterior interosseous nerve Pronator quadratus Main pronator Nerve → anterior interosseous nerve POSTERIOR FOREARM Main nerve → Radial nerve / posterior interosseous nerve Extensor carpi radialis longus Wrist extension + abduction Extensor carpi radialis brevis Wrist extension + abduction Extensor carpi ulnaris Wrist extension + adduction Extensor digitorum Extends fingers. Extensor pollicis longus Extends thumb. Extensor pollicis brevis Extends thumb. HAND — THENAR MUSCLES LOAF Lateral 3½ digits → median nerve Lumbricals 1 & 2 Median nerve Flex MCP Extend IP joints. Lumbricals 3 & 4 Ulnar nerve. Thenar muscles Abductor pollicis brevis → median Flexor pollicis brevis → median Opponens pollicis → median Classic Thenar atrophy + loss of thumb opposition → median nerve lesion. HAND — HYPOTHENAR Abductor digiti minimi → ulnar Flexor digiti minimi → ulnar Opponens digiti minimi → ulnar Most intrinsic hand muscles → Ulnar nerve Mnemonic: PAD/DAB PAD → Palmar interossei ADduct DAB → Dorsal interossei ABduct Both → ulnar nerve GLUTEAL MUSCLES Gluteus maximus Action → hip extension Also lateral rotation Nerve → inferior gluteal nerve Roots → L5–S2 Clinical Difficulty climbing stairs/rising from chair → gluteus maximus weakness. Gluteus medius Action → hip abduction Stabilizes pelvis during walking Nerve → superior gluteal nerve Roots → L4–S1 Trendelenburg sign Patient stands on right leg.

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