The Next Best Step Vignettes (USMLE Step 2 CK) with
complete solution
compare to previous chest x-ray
when you find a pulmonary nodule on chest x-ray
Pulmonary angiogram (gold standard), but usually used in CT pulmonary angiography
or CT with contrast
most accurate test in PE
NO LIP
Nitrates
Oxygen
Loops
Ionotropic drugs (dobutamine)
Positioning (blood pools in the legs)
BNP > 400
tx acute CHF
V/Q scan
if the patient cannot have CT angio then what imaging do you use to dx the PE
CT chest/abdomen/pelvis and PET to look for mets
next best step after finding a brain tumor on MRI
pleural:serum protein > 0.5
pleural:serum LDH > 0.6
pleural LDH > 2/3 serum LDH
Light's criteria for pleural effusion
LABA's
what type of asthma treatment should never be used alone
1. clinical scenario - unable to count to 10, use of accessory muscles, etc
2. O2 < 50
3. CO2 > 50
rule of 50's
when should you intubate
histoplasmosis
ohio missipi
cocciodes
southwest US
Wind - atelectasis
Water - UTI
Wound - wound infection
Walking - DVT
Wonder drugs -stuff we give them
W's of post-op fever
broncheoalveolar carcinoma
repeat lung infections in the same area in patient older than 40 years old
CHADS2 > 2
CHF
,HTN (140/70)
Age > 75
DM
Stroke/tia previous (2 pts)
requirement for anticoagulation in afib
amiodorone
tx for v tach with a pulse
BB and CCB
rate control a fib
< 48 hours - cardioversion
> 48 hours - get TEE to look for intracardiac clot and then cardiovert/ otherwise rate
control + anticoag
tx of a fib
1. abdominal x-ray to look for pneumoperitoneum
2. if so, then immediate surgery, if no then move to contrast enema -
a. if shows microcolon- meconium illeus- Gastriffin enema
b. if shows dilated macrocolon with taper- Hirshprung - recal biopsy
work up of bilous emesis
(progressive hip pain - can have normal physcial exam and x-ray findings early on) -
chronic corticosteriods - high RF - get MRI of the hip
next best step for avascular necrosis of the hip
halothane and succinylcholine - tx dantrolene
which anesthetics are associated with malignant hyperthermia? tx
cerebellum
in what part of the brain is the intention tremor
UMN
bulbar symptoms are associated with UMN or LMN
atropine, if non-responsive then epi/dopamine or transcutaneous pacing
tx of persistent bradycardia
amiodorone (always check LFT's, PFT's, and TFT's)
tx of ventricular tachy with a pulse
IV glucagon, K, and insulin
tx of suspected BB overdose
decrease in arterial elasticity
cause of isolated systolic hypertension
1. ACE -/ ARB
2. BB
3. spiranolactone
confer a decrease in mortality in CHF patients
no BB (crazy high BP), but yes to lorazepam
which drug should be given in a patient with cocaine-induced MI
BB/ CCB
rate control afib
adenosine
tx of supraventricular tachy
procanimide (look for the delta wave)
, tx of Wolf -parkinson white
pulmonary veins
where does afib originate
symptomatic - 70-99
assymptomatic 60-99
when is CEA recommended
IV fouresemide
tx of flash pulmonary edema in the context of an MI
for original one - Troponin T, then for second CK-MB
what marker do we use to diagnose a reinfarction
compression US
high pretest probability DVT
BUN/creat > 20
how to determine pre-renal failure
restrictive
cardiac calcifications
nausea/vomiting/diahrea, and confusion and weakness, can get colored vision changes
symptoms of digoxin tox
CCB
BB med that causes leg edema
ethycrynic acid
the only diuretic that is not a sulfa drug
azetazolamide
tx for intracranial hypertension
calcium (thiazide retain)
loop loose
thiazides
tx of nephrogenic diabetes insipidus
diverticulosis
GI bleeding > 40
pyelo
WBC in the urine
FQ (IV) - followed by outpatient oral
tx of pyelo
ceftriaxone
tx of pyelo in pregnancy
calcium oxalate
most common type of stone
uric acid stones ("you" unseen)
- alkalize the urine, gout and cancer
what stones can't you see
hyperparathyrioidism
RTA
when you see calcium phosphate stone what conditions should you think of
non-contrast CT stone
radio stones
complete solution
compare to previous chest x-ray
when you find a pulmonary nodule on chest x-ray
Pulmonary angiogram (gold standard), but usually used in CT pulmonary angiography
or CT with contrast
most accurate test in PE
NO LIP
Nitrates
Oxygen
Loops
Ionotropic drugs (dobutamine)
Positioning (blood pools in the legs)
BNP > 400
tx acute CHF
V/Q scan
if the patient cannot have CT angio then what imaging do you use to dx the PE
CT chest/abdomen/pelvis and PET to look for mets
next best step after finding a brain tumor on MRI
pleural:serum protein > 0.5
pleural:serum LDH > 0.6
pleural LDH > 2/3 serum LDH
Light's criteria for pleural effusion
LABA's
what type of asthma treatment should never be used alone
1. clinical scenario - unable to count to 10, use of accessory muscles, etc
2. O2 < 50
3. CO2 > 50
rule of 50's
when should you intubate
histoplasmosis
ohio missipi
cocciodes
southwest US
Wind - atelectasis
Water - UTI
Wound - wound infection
Walking - DVT
Wonder drugs -stuff we give them
W's of post-op fever
broncheoalveolar carcinoma
repeat lung infections in the same area in patient older than 40 years old
CHADS2 > 2
CHF
,HTN (140/70)
Age > 75
DM
Stroke/tia previous (2 pts)
requirement for anticoagulation in afib
amiodorone
tx for v tach with a pulse
BB and CCB
rate control a fib
< 48 hours - cardioversion
> 48 hours - get TEE to look for intracardiac clot and then cardiovert/ otherwise rate
control + anticoag
tx of a fib
1. abdominal x-ray to look for pneumoperitoneum
2. if so, then immediate surgery, if no then move to contrast enema -
a. if shows microcolon- meconium illeus- Gastriffin enema
b. if shows dilated macrocolon with taper- Hirshprung - recal biopsy
work up of bilous emesis
(progressive hip pain - can have normal physcial exam and x-ray findings early on) -
chronic corticosteriods - high RF - get MRI of the hip
next best step for avascular necrosis of the hip
halothane and succinylcholine - tx dantrolene
which anesthetics are associated with malignant hyperthermia? tx
cerebellum
in what part of the brain is the intention tremor
UMN
bulbar symptoms are associated with UMN or LMN
atropine, if non-responsive then epi/dopamine or transcutaneous pacing
tx of persistent bradycardia
amiodorone (always check LFT's, PFT's, and TFT's)
tx of ventricular tachy with a pulse
IV glucagon, K, and insulin
tx of suspected BB overdose
decrease in arterial elasticity
cause of isolated systolic hypertension
1. ACE -/ ARB
2. BB
3. spiranolactone
confer a decrease in mortality in CHF patients
no BB (crazy high BP), but yes to lorazepam
which drug should be given in a patient with cocaine-induced MI
BB/ CCB
rate control afib
adenosine
tx of supraventricular tachy
procanimide (look for the delta wave)
, tx of Wolf -parkinson white
pulmonary veins
where does afib originate
symptomatic - 70-99
assymptomatic 60-99
when is CEA recommended
IV fouresemide
tx of flash pulmonary edema in the context of an MI
for original one - Troponin T, then for second CK-MB
what marker do we use to diagnose a reinfarction
compression US
high pretest probability DVT
BUN/creat > 20
how to determine pre-renal failure
restrictive
cardiac calcifications
nausea/vomiting/diahrea, and confusion and weakness, can get colored vision changes
symptoms of digoxin tox
CCB
BB med that causes leg edema
ethycrynic acid
the only diuretic that is not a sulfa drug
azetazolamide
tx for intracranial hypertension
calcium (thiazide retain)
loop loose
thiazides
tx of nephrogenic diabetes insipidus
diverticulosis
GI bleeding > 40
pyelo
WBC in the urine
FQ (IV) - followed by outpatient oral
tx of pyelo
ceftriaxone
tx of pyelo in pregnancy
calcium oxalate
most common type of stone
uric acid stones ("you" unseen)
- alkalize the urine, gout and cancer
what stones can't you see
hyperparathyrioidism
RTA
when you see calcium phosphate stone what conditions should you think of
non-contrast CT stone
radio stones
