Step2 ck

posterior hip dislocation - K2

presents with Internal rotation, adducted hip, shortened

Moderate to sevre menopause tx.

with uterus-oral estrogen+progresterone, without uterus (hysterectomy)-tarnsdermal estrogen - K2

CSF in viral meningitis

lymphocytes high, protein high, glucose normal - K2

35 weeks, hemo stable mom and baby for placenta previa-

observation & elective C section at 36/37wks - K2

Glucocorticoids cause

eosinopenia, neutrophil increase and increase granulocyte - K2

65yrs=/> or 19-64 with immunocompromise -PCV15 then within ≥ 1 year give PPSV23 (or ≥ 8 weeks can be considered in immunocompromised individuals)// only for upto 18yr olds- PCV13 – K2

PPH MCC

uterine atony

Transvaginal cerclage placed when?

<24 weeks

what length short cervix

<25mm

Strongest RF for aortic dissection-

HTN (not smoking) - K2

Rubella rare sideeffect

ITP

kwasaki can cause

coronary artry anuerysm

parvovirus can cause

aplastic crises in erthema infectiosum (slapped cheek)- pure red cell aplasia

Alcohol hallucinosis vs delierium tremens timeline

12–48 hours after (normal vital signs, can have tremors) vs 48-96hrs (tachycardia, HTN, lack of orientation, confusion)

Aortic dissection vs MI vs PE

all can have SOB, chest pain, tachycardia but

sinus tachy, dimished distal pulses, differential bp in extremities, widened mediastinum, sudden anterior chest pain, muffled sounds (cardiac tamponade can develop)

vs

retrosternal chest pain, ST eleveation changes in ecg, also sinus tachy

vs

pleuritic chest pain, hypotension

tetracycline is contraindicated in

children < 8yrs

First-line treatment for Lyme disease in children, pregnant and lactating

Amoxicillin (doxycycline can also be for children but amoxi is first line), doxy contraindicated for pregannt or lactating

For CAP, chest xray or sputum culture first?

chest xray first, only for severe CAP, sputum culture

NF2 ass. -

meningioma, ependymoma, not RCC

Lowering ICP (aka reduce cerebral blood flow) by

hyperventilation

TIA coz of carotid artery stenosis dx.

US of neck (duplex US)

Mobitz type 2 (pic) (type 2 is not wenkebach) and third degree tx.

transcutaenous cardiac pacing (pacemaker)

amiodarone for what in heart

ventricular arrhythmia, supraventricular arrhythmia, and cardiac arrest.

dystonia (painful torticollis, stiff neck, ocuglogyric crises etc) tx.

benztropine, diphenhydramine

akathisia tx.

propranolol

Condylomata lata is

secondary syphilis

condylomata acuminata is

HPV (cauliflower like warts, usually asymptomatic)

BPH (bladder oulte osbtruction) ass. with what kidney issue

hydronephrosis (back pain bilateral etc)

serum osm>urine osm

DI (plus hypernatremia)

urine osm>serum osm

SIADH (plus hyponatremia, high urine Na+)

Definitive prenatal diagnostic test for fetal aneuploidy at ≥15 weeks?

Amniocentesis. Cell-free fetal DNA is a screening test, not diagnostic.

Before 15 weeks, chorionic villus sampling

Mixed cryoglobulinemia: complement levels?
.

Hypocomplementemia, especially low C4

Typical urine sodium in prerenal AKI?

Low urine sodium (<20 mEq/L)

Elderly patient with painless lower GI bleeding + iron deficiency anemia: likely diagnosis?

Angiodysplasia.

HIV patient with vascular skin lesions and Warthin-Starry stain positive: diagnosis?

Bacillary angiomatosis (caused by Bartonella species).

Car seat recommendation for toddlers?

Rear-facing car seat until at least age 2 or until the child exceeds the seat's height/weight

Sudden venous air embolism (diffuze wheezes, JVD (no JVD in anaphylaxis)) during surgery: immediate positioning?

Left lateral decubitus (Durant maneuver), often with Trendelenburg, to trap air in the right atrium and reduce outflow obstruction.

Situational (vasovagal) syncope triggered by?

Vasovagal reflex triggered by:

• Micturition

• Defecation

• Coughing

• Swallowing

• Laughing

Pronator drift indicates lesion where vs Romberg:?

UMN / corticospinal tract lesion vs Posterior columns / proprioception loss

Infant inguinal hernia management vs Hydrocele?

Pediatric surgery referral/elective repair

Reason:
High risk of incarceration.

vs

Usually observation.

Acute migraine medications besides NSAIDs/triptans?

IV anti-dopamine drugs:

• Metoclopramide

• Prochlorperazine

⚠ Do not combine triptans and ergot alkaloids.

If ricketsia suspected, do what?

start emoriic doxycylcine (dont wait confirmation-skin biopsy, pcr, serology testetc)

For infants born to mothers with HIV and a viral load < 50 copies/mL, PEP with what

vs

if mother's viral load is ≥ 50 copies/mL?

zidovudine for 4 weeks

vs

a two-drug regimen (zidovudine and nevirapine) or a three-drug regimen (zidovudine, lamivudine, and nevirapine or raltegravir) is recommended.

Nocardia: classic presentation and treatment?

• Weakly acid-fast branching filamentous gram-positive bacteria

• Opportunistic infection

• Lung + brain abscesses are classic

• TMP-SMX is first-line

NRDS.tx.

supplemental Oxygen → CPAP

Surfactant therapy only if:

• if severe disease

• worsening despite CPAP

• intubated infants
  Then if needed, mechanical ventilation (endotracheal intubation)

AECOPD tx.

Inhaled rapidly-acting bronchodilators (e.g., albuterol), systemic glucocorticoids (e.g., prednisone, methylprednisolone), and supplemental oxygen (titrated to a target saturation of 88–92%), empiric antibiotics

If o2 not helping, then NIPPV trial. if not mechanical ventilation

Long-term oxygen is reassessed after recovery

Classic presentation of developmental dysplasia of the hip (DDH)? tx.?dx.?

• Breech presentation

• Leg-length discrepancy

• Asymmetric thigh/gluteal folds

• Positive Ortolani/Barlow (newborn)
  
  

• tx. <6mnth olds- harness for6-8 weeks
  6–18 months → Closed reduction + Spica (after reduction)
  >18 months → Open reduction ± Osteotomy
  
  

• dx.<4–6 months: Ultrasound (femoral head not yet ossified).

• >4–6 months: Pelvic X-ray.

Legg-Calvé-Perthes disease, cause, sx.,xray, tx.?

• Idiopathic avascular necrosis of femoral head

• Limp + hip/knee pain

• Widened joint space/flattened femoral head

• <6 years: conservative (activity restriction/bracing)

• Older children: often surgery (femoral osteotomy)

Guillain-Barré syndrome CSF findings?

Albuminocytologic dissociation:

• ↑ Protein

• Normal WBC count

Cyclosporine classic adverse effects?

• 
  

• Gingival hyperplasia

• Nephrotoxicity

• Hypertension

• Hypertrichosis

HPV types causing genital warts?

• 6 & 11 → genital warts

• 16 & 18 → cervical cancer

Chorioamnionitis management?

Broad-spectrum antibiotics + induce prompt delivery

Cesarean only for standard obstetric indications (fetal distress, failure of dleivery to progress etc).

Obvious (from physical exam) joint dislocation with absent distal pulses, NBS?

Immediate closed reduction.

Do not delay for X-ray.

Initial symptomatic treatment of hyperthyroidism?

Propranolol.

Methimazole is definitive therapy (except first-trimester pregnancy, where PTU is preferred).

DIC vs TTP coagulation studies?

DIC

• ↑ PT

• ↑ PTT

• ↓ Fibrinogen

• ↑ D-dimer

TTP

• PT/PTT usually normal

pleural empyema, what pH and glucose for parapneumonic effusion and tx.

pleural fluid pH < 7.20 and glucose < 60 mg/dL.
tx. chest tube+antibiotics

crohns vs UC presentation

crohns -usually non bloody dirrhaea, RLQ pain(terminal ileum), more weight loss than UC, perinanal disease (skin tags, abscess)// UC-bloody, LLQ

Kid with slapped cheeks + perioral sparing + lacy rash after fever =? +tx.

erythema infectiosum (Parvovirus B19) → reassurance+ f/u

normal breastfeeding amount

8-12 feedings in 24 hrs

rabies PEP in vaccinated vs unvaccinated

rabies vaccine only

vs

rabies immuneglobulin + vaccine

C.difficile diarrhea tx.

Oral fidaxomicin/vancomycin, second line-metronidazole

obstructive vs restrictive flow vol loop

concave vs normal shape but reduced overall volume

standard deviation in normal distribution

1 SD (68%), 2 SDs (95%), and 3 SDs (99.7%). 87% is 1.5 SDs etc

High-Altitude Cerebral Edema (HACE) sx. and tx.

Symptoms of acute mountain sickness (headache most IMP sign) + Ataxia and/or altered mental status,

tx. Immediate descent (most important)

• Supplemental oxygen

• Dexamethasone

• Portable hyperbaric chamber if descent is not immediately possible

Pregnant + hypertension + abdominal/RUQ discomfort ± vague symptoms → what and what next step

HELLP until proven otherwise → AST/ALT + platelets.

immobility + symptoms = ?

VTE (PE) until proven otherwise.

Elderly, HTN, Diabetes, Recent splenic/renal infarct/stroke, think?

Afib

HBV exposure in an unvaccinated person/ vaccinated but no adequate response → PEP?

HBIG + complete hepatitis B vaccine series.

If previously vaccinated with documented immunity:
→ no HBIG needed.

Newborn with drooling, coughing, cyanosis with feeds → diagnosis?

Esophageal atresia ± tracheoesophageal fistula.

Hypovolemia (dry cracked lips) + hypernatremia → initial IV fluid?

0.9% normal saline first to restore intravascular volume.

Correct sodium gradually afterward with free water (regualr oral water with no significant electrolytes)/D5W

t test vs anova vs chi sqaure vs fishers etc when?

kidney stone shapes, calcium oxalate, calcium phospate, cystine, uric acid, struvite

calcium oxalate- envelope/dumbbell

calcium phosphate-rosette

cystine- hexagon
uric acid- rhomboid
struvite-coffin lid

Trastuzumab (her2 inhib.) adverse effect

dilated cardio (echo prior to starting drug)

surrogate decision maker order:

spouse, adult child, parent, sibling, and other relatives

constrictive pericarditis sx.,findings on exam and xray, cause

RHF+ preserved systolic function, pericardium calicifed, kussmaul sign (not in tamponade), JVP, chronic condition eventually lead to RHF, dyspnea, fatigue

Causes: TB, prior caridac surgery, radiation therapy

LR- vs LR+ formulas

LR- = (1 - sensitivity)/specificity
LR+ = sensitivity/(1 - specificity)

Arterial insufficiency (paresthesia, intermittent claudication) in his right calf and foot and palpable femoral pulses but absent right pedal pulses indicate

stenosis of the femoropopliteal artery (vs aortoiliac occlusive disease has decreased femoral pulse) NOT DVT

aortoiliac/vascular claudication vs lumbar spinal stenosis

• pain goes away just by stopping walking -AOC (walking, excercise triggers) (decreased femoral pulse)

• vs

• Pain improves only when sitting or leaning forward (improves with lumbar flexion )-LSS (standing or walking triggers) (normal pulse)
  
  

• both affect butt, thighs

adrenal crisis tx.

high dose hydrocortisone (glucorctriocids) + IV fluids (isotonic saline) + correct hypoglycemia

Acromegaly cardiac effect?

cardiomyopathy→ HF with reduced cardiac output

also hypertension, concentric ventricular hypertrophy, and arrhythmias

contraindications for breastfeeding?

herpetic lesions on the breast

if she is undergoing chemotherapy, certain medications (e.g., tetracycline, chloramphenicol, lithium)

if the baby has galactosemia

if active HIV (unless resource limited and no formula avaiable), maternal ebola

recreational drug use (cocaine), marijuana isnt contraindicated but strngly discouraged, also smoking not contraindicated but strongly discoruaged coz of SID risk

fragile x syndrome increases risk of what cardiac finding?

Mitral valve prolapse → mitral regurgitation.

Meigs syndrome?

Ovarian fibroma + ascites + pleural effusion

HOCM treatment vs sudden death prevention?

Symptoms → beta blockers. (second line-CCBs)
SCD prevention → ICD.

COPD patient becomes somnolent after high-flow (100%) O2. Why?

CO2 retention/hypercapnia.

Melena + epigastric pain + NSAID use → what and what next step?

UGIB (probably from PUD)→EGD

Bilateral motor/sensory deficits + sensory level + CSF pleocytosis = ?

Transverse myelitis.

What should be performed in all clinically stable neonates with suspected meningitis or signs of sepsis and no signs of increased ICP?

lumbar puncture (meningitis is neonates is vague sx., fussy crying irritable etc)

What antibody is associated with Graves disease

A: TSH receptor antibody (TRAb) / Thyroid-stimulating immunoglobulin (TSI) (‘stimulating’ turns ‘on’ thyroid so hyperthyrodism)

What antibodies are associated with Hashimoto thyroiditis?

• Anti-thyroid peroxidase (anti-TPO) ⭐ (also in postpartum thyrodiditis)

• Anti-thyroglobulin antibody

VHL manifestations →

RCC + hemangioblastoma (brain) + pheochromocytoma

What is the first-line treatment for variable decelerations (umbilical cord compression)?

Maternal repositioning (left lateral position). first line

others: Stop oxytocin, IV fluids if needed, and amnioinfusion if recurrent during labor (especially after rupture of membranes).

if recurrent nothing works, csection

What is the initial management of late decelerations?
(Uteroplacental insufficiency (fetal hypoxia))

Left lateral positioning + stop oxytocin + IV fluid bolus.

if recurrent, c section

Normal endometrial thickness for psotmenopausal

</=4mm

Tx. for renal stone >10mm and exceptions?

shock wave lithotripsy (except for stone in distal or middle ureter (first line) or morbidly obese with >10mm stone, do ureterorenoscopic removal endoscopy)

If stem mentions vaccines up to date, assume for that age they have all vaccines eg.?

17 year old with up to date vaccines, so HPV vaccine would be taken, so next is gonorrhea test (screening) in option

or if they r travelling, HAV vaccine they have

Idiopathic bells palsy tx.

Oral glucocorticoids within 72 hrs (no further testing req.)

Increasing inclusion criteria for LOW value test (lower number is diagnostic) does what to sn, sp, TP, FP etc

High senstivity, low specificity, high TP and FP, low TN and FN, low PPV, high NPV
(opp. for high value even if increasing IC)

congenital Zika syndrome sx, countries, how spread?

microcephaly, spasticity, sensorineural hearing loss, and pigmentary retinal mottling in this newborn (brazil trip), mosquito repellant prevention

Acromioclavicular joint injury vs rotator cuff sx., dx.

Cross arm adduction test, top of shoulder pain, x ray first

vs

range of motion affected, weakness, dx. mainly clincial but can do MRI