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STEP 2 NOTES Updated automatically every 5 mi

March 17th, 2025

● Patient less than 60 y.o. with dyspepsia, suspicious for
PUD, no alarm features → Urea breath test or stool
antigen for H. pylori
● Cricothyroidotomy: emergency temporary airway
management
● Tracheostomy: airway management for patients needing
long-term vent or upper airway obstruction causing
respiratory distress
● VBG during sleep apnea episode: decreased pH,
increased CO2, normal HCO3- because it takes 2-5 for
metabolic compensation
● Kidney stone guidelines:
○ ≤10 mm: send home with hydration protocol ±
tamsulosin
○ > 10 mm: admit
● Fetal genetic testing:
○ Cell free DNA: 9-10 wks
○ NT screen: 10-14 wks
○ Chorionic villus sampling: 10-13 wks
○ Amniocentesis: 15 wks+
○ Cordocentesis: 18 wks+
○ Triple screen/quad screen: 15-22 wks
● Abnormal uterine bleeding:
○ Regular menses + painless, light IMB = polyp
○ Regular painful, heavy menses women +
enlarged, boggy, uniformly enlarged uterus >40 =
adenomyosis
○ Postmenopausal woman + irregular, anovulatory
bleeding ± risk factors for unopposed E2 =
endometrial hyperplasia
○ Regular, heavy menses (± pain) + irregularly
enlarged, bulky uterus = fibroids
● Post-herpetic neuralgia → gabapentin
March 18th, 2025
UWSA1: 255
● ACTH-dependent Cushing syndrome: increased ACTH
→ hypertension (cortisol has partial mineralocorticoid
activity)
○ ACTH is a polypeptide hormone
○ Cortisol is a steroid hormone
● Labor:
○ Latent: 0-6 cm
○ Active: 6+ cm, normal progression of 1+ cm/hour
■ Protraction → oxytocin
■ Arrest → c-section
● No cervical change for 4 hours with
adequate ctx
● No cervical change for 6 hours with
inadequate ctx
● SBP is caused by intestinal bacterial translocation
(intestinal wall → ascitic fluid)
○ Commonly E. coli and klebsi
● Pregnant patient on antiepileptic meds or prior hx of NTD
(ex. anencephaly) → increase folate intake
● Polymyositis can cause elevated LFTs
● 2nd & 3rd trimester maternal hyperglycemia
complications:
○ NRDS
○ Macrosomia → shoulder
○ Neonatal HYPOglycemia
○ Organomegaly
○ Polycythemia (increased fetal met. demand →
hypoxemia → increase EPO)
:
 March 19th, 2025
● Heparin is safe during pregnancy (warfarin is teratogenic)
● Precautions for DTaP administration:
○ Uncontrolled seizure disorder
○ Moderate or severe illness
● Contraindications to DTaP administration:
○ Anaphylaxis
○ Encephalopathy <1 wk after dose of pertussis vax
● Argyll Robertson pupils: do not react to light but can
accommodate
○ Accommodation reflex: when something is moved
close to the eye, there is constriction of the pupil
(miosis), convergence (inward movement) of the
eyes, and lens increases in convexity
● Tertiary syphilis:
○ Neurosyphilis: + Romberg (due to tabes dorsalis),
A-R pupils
○ Cardiac syphilis: heart failure 2/2 ascending aortic
aneurysm
● Unprovoked DVT, unusual DVT location, recurrent DVT
→ cancer screening (colonoscopy, mammo, pap, DRE)
● Transmissible disease (HIV) → notify health department
● Air embolism: occur during neurosurgical procedures
when patients are in sitting position, removal of central
lines, penetrating lung trauma, barotrauma
○ Characteristic wind-mill or churning murmur
○ Sudden fall in end-tidal CO2
○ Move patient to LLD or T-berg
● Foul smelling pleural fluid = anaerobic infx
March 22nd, 2025
● FAP+ syndromes:
○ Gardener: FAP plus extracolonic bone ± soft tissue
lesions (ex. osteomas, epidermal cysts, retinal
pigment hypertrophy)
○ Turcot: FAP plus malignant brain tumors
(medulloblastomas in FAP or gliomas in HNPCC)
● ABO incompatibility: milder than Rh
● Rh incompatibility can result in full term birth with hydrops
○ Don't always miscarry
● Patellofemoral pain syndrome vs. patellar tendinitis:
○ PFP = anterior knee pain
○ PT = pain with pressure applied to patellar tendon
(inferior to patella or on the tibial tuberosity)
● Malignant melanoma negative prognostic factors:
ulceration and Breslow depth
● Sickle cell dx: made by smear, confirmed with hb
electrophoresis
● Biceps tendon rupture:
○ Distal: hematoma in medial region of cubital fossa,
limitation of flexion and supination, proximal
displacement of biceps belly upon contraction; no
movement of forearm with squeezing of bicep
○ Proximal: mostly painless, usually no significant
loss of function, distal displacement of biceps belly
on contraction
● Trauma-induced coagulopathy treatment: transfused
pRBC, FFP, and PCC in 1:1:1 ratio (regardless of Hb)
● Cat scratch fever treatment:
○ ImmunoCOMPETENT: azithromycin
○ immunoCOMPROMISED: doxycycline
● Anything gangrenous → immediately to OR
● SJS/TEN: develops shortly after initiation of lamotrigine--
NOT years in
● For patients with HSV1 mouth ulcers within 4 days of
onset who can’t eat/drink → oral acyclovir
● All patients with thyroid nodule get TSH and US: if TSH is
NORMAL or HIGH and US is concerning → FN
:
 ● Pregnant patient with severe HTN and pulmonary
crackles → pulmonary edema → preeclampsia with
severe features
● BPH treatment:
○ Finasteride decreases size of prostate, lowers
PSA, takes 6-12 months to work
○ Tamsulosin/terazosin relaxes smooth muscle in
bladder neck and urethra to improve symptoms--
no effect on prostate size, works immediately
● Genital herpes can be mildly painful or itchy with
systemic symptoms
● Adequate breast milk intake = 1 wet diaper per day of life
(ex. 4 diapers for a 4-day old) and at least 1 stool per day
● For a duodenal ulcer (improvement after eating), the
most important factor that relieves symptoms is H. pylori
treatment
○ For gastric ulcers, alcohol and smoking cessation
are important for symptom relief
● Normal neonate liver can be palpated 3 cm below costal
margin
● For ACTH-dependent Cushing's → high-dose dex
○ Decreased ACTH → pituitary MRI
○ No decrease in ACTH → ectopic production, chest
CT
● For primary hypercortisolism (ACTH-independent):
○ Exogenous CS use?
○ Suspected adrenal adenoma → CT abd
March 23rd, 2025
● Cigarette smoking is not a contraindication to
breastfeeding
● HRT is for women:
○ Less than 60 y.o. who have been going through
menopause for less than 10 years
○ Moderate-severe vasomotor symptoms affecting
quality of life
● Contraindications to HRT:
○ Coronary artery disease
○ VTE
○ Stroke
○ Endometrial or breast cancer
● For women without a uterus, only give oral or
transdermal estrogen
● For women with a uterus, given estrogen and progestin
● In adults, Hib is #1 cause of epiglottitis
● Supraglotic narrowing = laryngomalacia
● subglottic/trachea = croup
● Hydrocephalus due to toxo infx can present as lower limb
spasticity (UMN signs)
● The lower the pretest probability (ex. a patient who is
asymptomatic for HEV), the lower the PPV (ex. a positive
:
 test in this patient is less likely to indicate actual HEV
infx)
● Intrahepatic cholestasis of pregnancy:
○ 3rd tri
○ Intense pruritus
○ Jaundice
○ Nonspecific features of acute hepatitis
○ Mild bili elevation (<6)
○ NO acute liver failure, hemolysis or
thrombocytopenia
○ Treat with urso and maybe first-gen antihistamines
for pruritis
● Acute fatty liver of pregnancy:
○ 3rd tri
○ Acute hepatic failure
○ Hemolysis
○ Increase ALT/AST
○ Thrombocytopenia
○ Hypoglycemia
○ Leukocytosis
○ SEVERE hyperbili
○ Treat with urgent delivery
● HELLP syndrome: form of preeclampsia
○ Hemolysis
○ Elevated liver enzymes
○ Low platelets
○ Hypertension
○ Proteinuria
○ Occasionally DIC
○ Treat with fluids and delivery
● Confirm PSC with MRCP or ERCP
● By 1 year old, babies should triple their birth weight and
be 1.5x birth length
● Erb palsy (waiter’s tip): upper trunk of brachial plexus
(c5-c6)
● Klumpke palsy (claw hand): lower trunk of brachial plexus
(c8-t1)
● Fetus that does not descend below -4 station despite
adequate ctx and >4 hours of pushing → cephalopelvic
disproportion
● Contraction intensity should be greater than 50 mmHg to
be adequate
● IV acyclovir + hospitalization criteria for herpes
zoster patients requires at least 1 of the following:
○ Dissemination through 3 or more dermatomes
○ Visceral organ involvement
○ More than 20 extradermatomal lesions
○ Immunocompromised
● Omeprazole is a CYP450 inhibitor, can increase warfarin
concentration
● Cushing syndrome algorithm:
:
 ● Initial tests for Cushing syndrome (too much cortisol):
○ 24-hour urine cortisol
○ Late-night salivary cortisol
○ Low-dose dex suppression test
● For ACTH-dependent (high ACTH, high cortisol) Cushing
syndrome:
○ HIGH-dose dex suppression test (decreased
ACTH/cortisol → ACTH-secreting pit adenoma →
MRI)
OR
○ CRH stimulation test (increased ACTH/cortisol →
ACTH-secreting pit adenoma → MRI)
■ Negative CRH-stim and high-dose dex tests
= ectopic ACTH → CT CAP to look for
ACTH-secreting tumor
● Initial tests for primary adrenal insufficiency (too little
cortisol):
○ Early morning salivary cortisol
○ ACTH (cosyntropin) stimulation test
○ Plasma ACTH
● Neuroblastoma vs. nephroblastoma (Wilm’s tumor):
○ Neuro: irregular mass, crosses midline, presents
before 2nd year of life with constitutional
symptoms likes fever, FTT
■ Opsoclonus-myoclonus syndrome
○ Nephro (Wilm’s tumor): smooth, regular mass,
usually does not cross midline, hematuria,
sometimes abdominal pain and hypertension
● TACO vs TRALI:
○ TRALI: signs of pulmonary edema, hypoxemic
respiratory insufficiency, and hypovolemia
(hypotension, tachycardia)
○ TACO: signs of volume overload-- hypertension,
S3, JVD
● MEN mutations:
○ MEN1: MEN1 gene → menin protein
○ MEN2: RET gene → increased tyrosine kinase
activity
● First step of volvulus: endoscopic detorsion with flex sig
→ rectal tube → sigmoidectomy within 72 hours of
detorsion
● Glucose levels in DKA RARELY exceed 600
● Fall on hand → pain with pinching and gasping →
scaphoid fracture
● Ulipristal and levonorgestrel have higher failure rates in
the 2nd half of the menstrual cycle and in obese or
overweight women
● Only do needle thoracostomy first for tension PTX
:
 ● PTX from mechanical ventilation is a CLOSED PTX, not
tension, because the air comes from the lung not from
the outside
● HCG levels for US:
○ Transabdominal: 6500 +
○ TVUS: 1500-2000+
● Legg-Perthes-Calve disease: idiopathic osteonecrosis of
the femoral head
○ Age 6+ = worse prognosis
● Cyanide poisoning symptoms:
○ Lactic acidosis
○ HAGMA
Confusion
○ Headache
○ Flushing
○ Bright red retinal veins
● Obstructive pattern = ratio <.70
● Rabies PEP (vaccination + IVIG):
○ Domestic herbivore: none
○ Domestic carnivore:
■ 10-day observation for signs of rabies → if
symptoms, PEP and test animal
■ Unavailable for observation: PEP
○ Wild animal:
■ Test animal: if + → PEP
■ If animal is not able to test → PEP
● LAD: due to deficiency in CD18 (subunit of beta-2
integrin)
● Serum-sickness like reaction symptoms:
○ Periorbital edema
○ Diffuse, pruritic rash all over body
○ Generalized LAD
○ Arthralgias
○ Mild proteinuria
● WPW EKG findings:
○ Delta wave (can be subtle)
○ SHORT PR
○ Wide QRS (>120 ms or 3 small boxes)
● Coarctation of the aorta:
○ Ductal-dependent CoA: differential cyanosis, blue,
hypoperfused lower extremities
○ Ductal-independent: brachial-femoral delay and
BP differential
● prominent/enlarged cerebral sulci = Alzheimer’s
March 26th, 2025
NBME 9: 256
● Botulism diagnosis: stool sample for culture and toxin
testing (infants), or toxin analysis in serum/body fluids
● Vestibular neuritis/labrynthitis is generally treated with
antiemetics/vestibular suppressants acutely, steroids not
routinely given
● Diaper candidiasis: treat with topical nystatin or azoles
● First-line treatment for mild acne: benzoyl peroxide and
topical retinoids
● Lytic bone lesion is more likely mets than primary tumor
● Alcoholic hepatitis → increased GGT regardless of time
since last EtOH use
● Giardia has a long latency period and can present up to a
month after infection during travel
● Cholera has a more acute and severe course than
Giardia
● DO NOT prescribed alpha blockers for a person with
BPH and orthostatic hypotension
● Injury to left ribs 9-11= splenic injury
● Diagnose bone tumors with biopsy
● POPs or progestin-only LARCs can be used in patients
who have migraine with aura
● Sexual dysfunction from menopause vs. MDD: whichever
came first, treat that (unless super obviously 1 or the
other)
March 27th, 2025
● specificity= 1- false positive
● New diagnosis of HIV without antibody to Hbsag = hep b
vaccine
○ Also flu and pneumovax
:
 ● Prescribe SSRI for patients who have medication-
induced depression or depression due to other medical
condition
● Tonometry before gonioscopy
● Unstable angina = hospitalize and cath
● CoA can present with an epigastric bruit in children
● For suspected RCC on CT, perform nephrectomy
● For bipolar patients who are having manic delusions or
psychosis, treaty them with an antipsychotic (NOT a
mood stabilizer-- ex. pick haldol over valproate)
● All patients with DKD and GFR > 20 get an SGLT-2 inh,
regardless of A1c
● Epidural hematomas = middle meningeal artery, lucid
interval, pupillary defect and contralateral focal neuro
deficits
● Kids with asplenia → PCN ppx until age 5
● NPH → ventriculomegaly on MRI brain
● Flail chest due to rib fractures → PPV
● Children can get Bell palsy
March 28th, 2025
● Trial of labor after c-section is biggest risk factor for
uterine rupture
● Acute cholecystitis vs. choledocholithiasis:
○ Choledocholithiasis: biliary colic, signs of
cholestasis-- icterus, increased ALP and GGT,
absence of fever
○ Acute cholecystitis: fever, murphy sign, abdominal
pain, nausea, vomiting
● Treatment of MS:
○ IFN-beta
○ Glatiramer to prevent relapses
○ Natalizumab: MAb against alpha-4-integrin
receptors and prevent lymphocyte invasion of
CNS
● Aromatase deficiency: unable to convert androgens to
estrogen (increased serum testosterone and decreased
estrogen)
○ Maternal virilization during pregnancy
○ 46XX: ambiguous genitalia at birth → virilization
with impaired secondary sex characteristics
(amenorrhea, lack of breast development),
osteoporosis
○ 46XY: tall stature, abnormal sperm production,
osteoporosis
● Whipple disease can present with arthritis, loose stools,
malabsorption (weight loss, IDA), hyperpigmentation,
generalized LAD
● Cat bite → prophylaxis with augmentin
● Placental abruption vs uterine rupture:
○ Placental abruption: abdominal pain, rigid uterus,
hypertonic contractions ± hemodynamic instability
○ Rupture: severe onset abdominal pain
with sudden pause in contractions, loss of fetal
station, hemodynamic instability, soft uterus
● Preeclampsia without severe features (new or known) →
induction at 37 weeks
● Pronator drift = UMN lesion
● MM can cause AL amyloidosis
● Introduce cow’s milk at 1 year
● 6 months old: introduce solid foods and continue vitamin
D until 1 year old for all exclusively breastfed infants
● Dx of aortic dissection:
○ HDS: CT angio
○ HDUS: TEE
● For PCN allergy, treat GAS with macrolides (including
clarithromycin)
● Depression with peripartum onset = onset during
pregnancy or within 4 weeks of delivery
● For patients with refractory ascites (no relief with
abstinence, Na restriction, and diuretic therapy) → serial
large-volume paras with albumin supplementation
● TIPS is contraindicated in patients with CHF
● Acute otitis externa treatment:
○ Uncomplicated: topical steroids, abx (cipro or
gent), and antiseptic like alcohol or acetic acid
:
 ○ Complicated (i.e., immunosuppression, diabetes,
severe AOE with cellulitis of face/neck): oral cipro
or gent, topical steroids and antiseptic
● Treatment of uric acid stones: urine alkalinization with
potassium citrate (or sodium bicarb/citrate), allopurinol,
low purine diet
○ Probenecid does NOT prevent stones-- only
prevents gout attacks because it increases uric
acid excretion in urine, increasing risk of UA
stones
● Chronic gout treatment:
○ First-line (XOIs): allopurinol and febuxostat
○ Second- line (uricosurics): probenecid
○ Third-line (recombinant uricase): pegloticase
● 2 parents with alpha-thal minor → CVS
● 2 parents with alpha-thal major → terminate/adopt/sperm
donor
● ACLS: after 3 attempts at defib, add amio or lido
● VSD with shunt reversal → low systemic O2 sat due to
right to left shunt → compensatory polycythemia
● Osteomyelitis in IVDU → cover staph and pseudomonas
(vanc and cefepime)
● Thoracic outlet syndrome → physical therapy
● Can keep long acting insulin (glargine) in hospice
patients since it does not require fingersticks like SAI--
d/c antihypertensives
March 31st, 2025
● Ulcer locations:
○ Medial malleolus: venous insufficiency
■ Edema, brown discolorations, varicose
veins, warm skin
■ PAINLESS
○ Lateral malleolus: arterial insufficiency
■ Shiny skin, reduced hair growth, cold skin,
weak/absent pulses
■ PAINFUL
○ Plantar surface of foot: neuropathic ulcer
■ Decreased sensation, reflexes
■ PAINLESS

● Genito-pelvic pain disorder (vaginismus): more

than 6 months of pain with intercourse, tightening
of pelvic floor muscles with penetration (speculum
exam)
● Vulvodynia: soreness and burning of vulva
triggered by touch or felt continuously
● Vascular ring vs. tracheomalacia vs.
laryngomalacia:
○ Vascular ring: respiratory symptoms and
esophageal compression showing tracheal
bowing and narrowing on X-ray; symptoms
improve in supine position
○ Laryngomalacia: inspiratory stridor that
worsens in supine position; txt with
supraglottoplasty
○ Tracheomalacia: expiratory
stridor, barking cough, noisy breathing,
hyperextension of neck for relief of
symptoms
:
 ● Disorders of sex development:

Disorder Pathophys Karyotype External Genitalia Internal Breasts? Serum

Genitalia androgens

Androgen End-organ 46XY Female (vagina ends Male + High

insensitivity sensitivity to in blind pouch) (undescended (aromatase
syndrome androgens testes, absent in adipose
uterus and tissue
tubes due to converts
production of androgens
AMH by to
testes) estrogen)
Aromatase Absent 46XX During Female - High
deficiency aromatase → (normal pregnancy: maternal
decreased male virilization
conversion of development
testosterone to in 46XY) At birth: ambiguous
estrogen → genitalia
decreased
serum Puberty: impaired
estrogen and breast development,
increased primary amenorrhea,
serum virilization (hirsutism,
testosterone severe acne)
XX and XY:
Osteoporosis,
hyperglycemia, tall
stature, weight gain
5-alpha- Defective 5- At birth: Male - High or normal
reductase alpha- Female or testosterone, low
deficiency reductase → ambiguous (normal DHT
decreased hormone levels at
conversion of birth)
testosterone to
DHT → Puberty:
decreased Virilization, testicular
DHT- descent, and male
dependent secondary sex
masculinization characteristics due to
of external high testosterone
genitalia and
prostate
● For patients with a large stone and signs of infx + shock
→ perc nephrostomy until UTI clears and then lithotripsy
or ureteroscopy
● Small stone with infx → stent
● In women with functional hypothalamic amenorrhea and
a BMI greater than 18.5 who want to get pregnant,
administer pulsatile GnRH to increased FSH/LH to
induce ovulation
● For patients with TEF, look for VACTERL anomalies:
○ Vertebral
○ Anal
○ Cardiac
○ TEF
○ Esophageal atresia
○ Renal
○ Limb malformation
● All transplant recipients receiving calcineurin inhibitors
(tacrolimus, cyclosporine) must be monitored for kidney
injuries
○ Other side effects: neurotoxicity, metabolic
abnormalities (glucose intolerance, hyperkalemia),
HTN
● Undulant fever, moldy hay, night sweats → brucellosis
● Shoulder pain with overhead activity with + drop arm test
and no relief of pain with lido injection → rotator cuff tear
(supraspinatus tendon is most common tear)
● DHEA is produced in the adrenal cortex but is secreted in
response to ACTH, thus it is decreased in
panhypopituitarism; however, no effect on
RAAS/potassium
● Trachoma conjunctivitis does not only happen in
neonates
:
 ● Zenker diverticulum is diagnosed with barium swallow
○ Can be missed with EGD
● Caustic ingestion → upper endoscopy within 12-24 hours
to assess extent of injury
● Ocular chemical burn → irrigation for at least 30-60
minutes followed up broad-spectrum abx
● Given nimodipine after SAH to reduce risk of vasospasm
● Neutropenic fever → cover pseudomonas → add
ampho b after 72 hours of fever
● Endometrial hyperplasia is treated with progestin
● Asymptomatic AAA → dx with US
● HDS + symptomatic AAA → dx with CT angio
● Dx OM of the spine with MRI first
● PP65 antigen = CMV infx
● RSV treatment is not indicated for SpO2 greater than
90%
● Oral leukoplakia → biopsy of lesions
● Alopecia, abnormal taste and smell, dermatitis, diarrhea
= zinc deficiency
● Selenium deficiency = hypothyroidism, myocardial
necrosis
● Slow labor:
○ Prolonged latent phase:
■ Nullip: more than 20 hours to get to 6 cm
■ Multip: more than 14 hours to get to 6 cm
○ Prolonged active phase: at 6 cm+, cervical change
is less than 1 cm per 2 hours
○ Arrested active phase:
■ Adequate CTX: no further cervical dilation
past 6 cm after 4 hours → c-section (pitocin
will not augment labor as CTX are already
adequate)
■ Inadequate CTX: no further cervical dilation
past 6 cm after 6 hours
○ Prolonged second stage (arrest of descent): at 10
cm without adequate fetal descent after
■ Epidural: 4 hours (nullip) or 3 hour (multip)
■ No epidural: 3 hours (nullip) or 2 hour
(multip)
● Renal replacement therapy (dialysis) increases risk of
CVD 20x, most common cause of death in these patients
● Neonate with mediastinal shift and bowel loops in the
thoracic cavity → think diaphragmatic hernia
● ToF causes R axis deviation due to RV hypertrophy
● Seizures can cause postictal lactic acidosis
● Peds patient with white plaques and anal fissures =
lichen sclerosus
● Acetaminophen overdose treatment:
○ Within 4 hours → activated charcoal
○ At 4 hours, measure APAP levels and administer
NAC is criteria is met
● Terminal breathlessness in cancer patients → increase
opioids if non-pharm measures dont work
● First-line for smoking cessation: varenicline and
wellbutrin
● Grip strength, wrist drop, midshaft humerus = radial
nerve
● Fractures of the humerus:
○ Surgical neck = axillary n. and a.
○ Midshaft = radial n. and brachial a.
○ Supracondylar = median n. and brachial a.
○ Medial epicondyle (cubital fossa) = ulnar n.
● Asymptomatic PFO in a child (ASD murmur) → no
intervention
April 2nd, 2025
NBME 10: 255
● TACO can present within hours of transfusion
● If patient wakes up with symptoms of ischemic stroke,
they are not candidate for TPA/TNK as their LKW was
more than 4.5 hours prior
○ Instead, give aspirin
● Child with unilateral cervical mass (LAD) with overlying
discoloration and granulomas on bx → mycobacterium
avium
:
 ● Osteosarcoma diagnostic pathway: X-ray → MRI → bone
biopsy
● For patients HFrEF, only give fluids if there is evidence of
HYPOtension from their secondary condition
● PPD sizes:
○ High risk (immunosuppressed with CS or tnf inh,
organ transplant, prior TB, HIV) = 5 mm
○ Intermediate (healthcare workers, moved recently
from endemic country, work/reside in homeless
shelter/prison, DM, CKD, IVDU, healthcare
workers) = 10 mm
○ Low risk = 15 mm
● Asthma exacerbation more likely due to viral URI than
PNA and chest X-ray will show consolidation if PNA
● For patients with prior 3rd trimester fetal demise, weekly
NST should be performed starting at 32 weeks
● CMV colitis can affect patients with severe colitis → look
for bx with intracellular inclusion bodies
● Brain death: can remove mechanical ventilation without
family consent
● New onset Afib → check TSH
● Wound infection with fever, severe pain, erythema,
crepitus or bullae → nec fasc → debride
● Gestational trophoblastic neoplasm: increased hCG
following pregnancy loss/abortion
○ Invasive mole: develops after molar pregnancy,
invades myometrium
○ Choriocarcinoma: most commonly follows normal
pregnancy, invasive, distant mets (lungs); present
with vaginal bleeding, abd/pelvic pain, increase
hCG
● Acute TTP → plasmapheresis
○ Can be augmented with CS and rituximab
● Myotonic dystrophy: presents in adults with decreased
relaxation after handgrip, cataracts, muscle weakness
● Spinal muscular atrophy:
○ Infantile: decreased mobility, respiratory distress,
difficulty feeding, death from respiratory failure
○ Intermediate: patients never learn how to stand or
ambulate independently
○ Juvenile: previously independent ambulation
followed by loss; proximal muscle weakness in
arms and legs, can develop spinal anomalies
(scoliosis, hyperlordosis)
● Lifestyle mods for HTN:
○ Smoking cessation
○ Weight loss
○ Limit dietary salt
● Aortic dissection can cause cholesterol emboli
● Obstructive pattern: decreased ratio, decreased peak
expiratory flow rate
● Oral rehydration is preferred in patients with
gastroenteritis for patients without severed electrolyte
abnormalities, sepsis, and those who can tolerate PO
● FSE placement contraindicated in HIV+ mom, active
HSV-2 lesions, hep B/C
● For suspected familial hemophilia in a neonate → test
cord blood for factor concentration if baby is a boy
● Patient who takes regular CS but abruptly stops taking →
HDUS → adrenal crisis → administer steroids
● Benztropine is an anticholinergic
● HSV infx is not always localized to anterior oropharynx
(gingivostomatitis); can also cause pharyngotonsillitis on
the tonsils and posterior pharynx
○ Ddx with herpangina: occurs mostly in children 3-
10 y.o. In summer and fall
● IgA deficiency: often asymptomatic but can manifest with
recurrent mucosal infx (sinusitis, respiratory infx, otitis
media)
○ No IVIG, txt during acute infx
● Cutaneous leishmaniasis causes an eschar
● Recurrent aspiration of liquids after stroke → thickening
agent
● Postpartum thyroiditis treatment:
○ Hyperthyroid phase (transient): beta blocker
:
 ○ Hypothyroid state: synthroid if symptomatic (most
patients return to euthyroid state)
● Large, firm, irregular breast mass → biopsy
● To assess for recurrence of medullary thyroid cancer,
check calcitonin
● To assess for recurrence of papillary or follicular thyroid
cancer, check thyroglobulin
● In a patient with cardiogenic shock due to CHF, give
inotropes (dopamine, dobutamine, norepi)
● CHF vs PE:
○ CHF: S3, pitting edema,
● Medication overuse headache
○ Can be due to NSAIDs/APAP alone or with
caffeine
○ Usually with a preexisting headache disorder like
migraine that then becomes tension headaches
○ Common in females
● Hyphema
○ Blood in the anterior chamber of the eye causes
by disruption of vessels
○ Caused by:
■ Trauma
■ Coagulopathies/hemoglobinopathies
(SCD)
■ Sudden change in IOP
● Alcohol withdrawal vs. THC intoxication
○ THC:
■ Tachycardia
■ Tachypnea
■ Tremor
■ Arrhythmia
■ increased/decreased BP
■ Conjunctival injection
■ Nystagmus
■ Mydriasis
■ Urinary retention
■ Dry mouth
■ Increased appetite
● L4 radiculopathy vs femoral neuropathy
○ Femoral neuropathy: usually due to diabetes,
direct nerve injury (stab wound, pelvix fx),
iatrogenic, tumors, psoas hematomas
■ Impaired hip flexion and knee extension
■ Pain in inguinal region with relief during
external rotation and flexion
○ L4 radiculopathy:
■ Sensory deficits: anterolateral thigh, patella,
medial aspect of leg and medial malleolus
■ Motor deficits: hip flexion and knee
extension
■ Reflex: patellar
● Imaging for radiculopathy or spinal stenosis is not
necessary if it is acute; get MRI without contrast if the
symptoms worsen or persist after 4-6 weeks of
conservative management
○ Acute back pain without red flags or neuro deficits
= no imaging
○ Red flags for back pain:
■ < 18 years old or > 50 years old
■ Hx of cancer/unexplained weight loss
■ History of AAA
■ IVDU
■ Long-term CS use
■ Cauda equina
■ Motor weakness
■ UMN signs
■ LMN signs
● Vertebrobasilar insufficiency vs cervical DDD
○ VBI: vertigo, tinnitus, dysarthria, dysphagia, gait
ataxia, gait ataxia
○ Cervical myelopathy: neck pain and stiffness,
impaired sensation in hands, gait instability,
weakness, clumsiness, positive Lhermitte sign
■ LMN at the level of the lesion (weakness/
atrophy in the arms with hyporeflexia)
:
 ■ UMN below the lesion (weakness,
increased tone, hyperreflexia in LEs, +
Babinski)
● Worsening of back pain with sitting → disk herniation
● Straight leg test = lumbosacral radiculopathy
● Tdap vaccine in pregnancy: between 27 and 36 weeks
● Who gets abx ppx for dental procedures:
○ Unrepaired congenital cyanotic heart disease
○ Prosthetic valve
○ Prior bacterial endocarditis
● Neuropathic pain not responsive to
opioids/APAP/NSAIDs → add TCA
● Umbilical artery catheterization can cause renal artery
thrombosis in infants
● Sudden onset of difficulty breathing in a child without
signs of anaphylaxis → assume foreign body aspiration
→ bronchoscopy
● For BCC of the head and neck → Mohs
April 3rd, 2025
● Esophageal cancer:
○ SCC:
■ Most common worldwide
■ Upper ⅔ of esophagus
■ Risk factors:
● EtOH
● Smoking
● Nitrosamines
● Low fiber
○ Adenocarcinoma:
■ Most common in the West
■ Lower ⅓ of esophagus
■ Risk factors:
● GERD and Barrett
● EtOH
● Smoking
● Obesity
● Recurrent ear infections, retracted TMs that do not
insufflate + language and speech delay in child = otitis
media with effusion → tympanostomy tubes
● Recently hospitalized patient with suspected c. diff but
has bloody diarrhea → still assume c. diff (avoid
premature closure)
● Galactocele vs. fibroadenoma US findings:
○ Galactocele: smooth, firm, nontender mass,
usually subareolar, complex, heterogeneous mass
with variable echogenicity
○ Fibroadenoma: homogenous mass
● Stroke patient with regurgitation of liquids → video
fluoroscopy
● Hemodynamically stable with suspected TAA → CTA
○ TTE for HDUS
● AAA rupture: confirm with US/POCUS
● First-line txt for AIHA: steroids
○ Vs. TTP which is treated with plasmapheresis
● Hantavirus causes either
○ Hemorrhagic fever with renal syndrome
■ Prodromal: fever, chill myalgias
■ Latency period
■ Respiratory failure and AKI
○ Hantavirus cardiopulmonary syndrome
● Maternal serum screen results:
○ Increased AFP only = neural tube defects
○ Decreased AFP and estriol, increased inhibin A
and beta-hCG = trisomy 21
○ Decreased AFP, estriol and beta-hCG = trisomy 18
● Hot tub folliculitis = pseudomonas
● Umbilical cord prolapse
○ Presentation: abrupt change from normal fetal
monitoring to fetal brady/recurrent decels
○ Risk factors:
■ Induction of labor
■ Assisted vaginal delivery
■ Low birth rate
■ Prematurity
■ Polyhydramnios
:
 ■ Breech
● PSC vs. PBC pathophys:
○ PSC: inflammation and fibrosis of the biliary tree
○ PBC: destruction of intrahepatic bile ducts
● Central precocious puberty:
○ Diagnosed with positive GnRH agonist stimulation:
administration of GnRH agonist → increased
serum LH 2x median
○ Next step is brain MRI
● Joint pain + kidney stone + bumps on skin (tophi) → gout
● Suspected Boerhaave syndrome → CT chest
● Malignant melanoma can met to gallbladder
● PPROM management:
○ Less than 34 weeks: ampicillin, azithromycin,
corticosteroids
○ 34+ weeks: SSE
● Hydatid cyst due to echinococcus = anaphylaxis during
surgery (dog-owner)
● Urethral injuries:
○ Posterior urethra tear: suprapubic pain, inability to
void, blood at meatus, high riding prostate due
to rupture of puboprostatic ligament
○ Anterior urethral tear: inability to void, blood at
meatus, perineal tenderness (usually caused by
straddle injuries, iatrogenic, penile fracture)
● PAD treatment:
○ Everyone with symptoms and ABI less than 0.9
= DAPT
○ Stenting = chronic limb ischemia (ulcer, gangrene,
resting pain) or medical treatment failure
○ Bypass (operative vascular reconstruction):
medical treatment failure or chronic limb ischemia
(ulcer, gangrene, resting pain)
● Central cyanosis + imperforate AV septum = tricuspid
atresia
○ Left axis deviation on ECG due to RV hypoplasia
and LV hypertrophy
● Child with analgesic ingestion (unknown) + elevated LFTs
+ AMS = Reye syndrome → hepatic mitochondrial injury
● Factor V leiden = resistance to protein C
● Radiation-induced pericarditis:
○ Acute: neutrophilic infiltration of the pericardium
(months)
○ Chronic (constrictive) pericarditis: fibrotic
thickening of the pericardium that occurs years
after radiation
● Breast abscess txt:
○ Intact skin without skin necrosis: FNA with US
guidance
○ Necrosis of overlying skin (purple, thin
appearance): I&D
● Leukemias:
○ AML: MPO+, CD13, CD33, CD34, and CD117 +
○ Hairy cell: CD20+
○ CLL: CD19, CD 20, CD23 +, Tndt+, PAS+
○ ALL: Tndt+, PAS+
● Acute vs chronic leukemia:
● When optimizing multiple process, the first to be
optimized should be the one with the highest coefficient
of variation (SD/mean)
● Neonatal fluid resuscitation:
○ < 10-14 days of life = umbilical vein
○ Septic patients without AC access after 3 attempts
= IO
● Hairdressers, dry cleaners, other occupations with
chemical exposure + rash → think contact dermatitis,
even if there are no new exposures
● Hospital-acquired PNA → vanc and cefepime
● UNILATERAL SNHL and tinnitus → brain MRI for
schwannoma
○ Presbycusis is not unilateral
● Acute lupus exacerbation → steroids
● Ischemic microangiopathy vs PCOM aneurysm:
○ PCOM aneurysm: causes compression of CN3
with pupillary involvement of the parasympathetic
:
 layer of CN3 that controls pupil dilation,
accommodation, and light reactivity
○ CN3 palsy due to DM: pupil-sparing
● Choanal atresia: cyanosis when feeding, improvement
when crying
● Patient with EPS from antipsychotics → switch to 2nd
generation antipsychotic
○ Quetiapine
○ Risperidone
○ Olanzapine
○ Aripripazole
○ Clozapine
● In a patient with CKD with uremic coagulopathy, there will
increased bleeding time, normal platelet count, normal
PT and PTT
● Small cell lung cancer txt: polychemotherapy and
radiation
● Non-small cell lung cancer txt: EGFR inhibitors (gefitinib)
● Greenstick fracture treatment: casting only
● Testicular tumor markers:
○ Seminoma: mildly elevated beta-hCG
○ Yolk sac tumor: AFP
○ Leydig cell: androgen excess
○ Choriocarcinoma: beta-hCG > 1000
● Polyps:
○ High risk: adenomatous (tubular, tubulovillous,
villous)
○ Highest risk: villous
● HOCM management:
○ Hx of arrest = defibrillator implanted
○ No arrest = bb
● Schatzki ring = circumferentia eso narrowing from GERD
→ txt with mechanical dilation
● Periumbilical tenderness → think appendicitis
● Preterm infants are more at risk for IDA
● Smoking cessation during pregnancy → counseling
○ Varenicline not tested in pregnancy
● Looks like cauda equina after epidural placement →
spinal epidural hematoma → surgical decompression
● Non-muscle invasive urothelial carcinoma →
transurethral resection
● Muscle-invasive urothelial carcinoma → either partial or
radical cystectomy
● Osteogenesis imperfecta vs. EDS:
○ OI: short stature, fractures, hypermobility, bone
deformities
○ EDS: hypermobility, bleeding, hyperextensible skin
(no fractures or short stature)
● Antipsychotics:
○ High-potency typical: increased risk of EPS
■ Haldol
■ Fluphenazine
■ Trifluoperazine
○ Low-potency typical: increased risk of
anticholinergic and antihistaminergic effects
(orthostatic hypotension due to alpha1 blockade)
■ Chlorpromazine
■ Thioridazine
○ Atypical:
■ Quetiapine
■ Risperidone
■ Olanzapine
■ Aripripazole
■ Clozapine
● Acute COPD exacerbation txt (ABCO):
○ IV/oral steroids
○ SHORT-acting SABA or SAMA (albuterol over
tiotropium)
○ O2
○ Abx
● Noncontrast CT will show hemorrhage OR ischemia
(hyperdense/white lesions)
● Elderly person with HTN urgency AND confusion →
hospitalize (nosebleeds can be normal sign of HTN
but confusion = end organ damage)
:
 ● Pyoderma vs venous insufficiency description:
○ Pyoderma: necrotic, ulcerated base with purplish
borders, growth, anterior leg, VERY PAINFUL
○ Venous ulcer: MEDIAL MALLEOLUS,
hyperpigmentation, ulceration, MILD
PAIN/PRURITIS
● Vesicoureteral reflux shows retrograde flow up the ureter
○ Causes renal scarring
● Hypoxia and unresponsiveness post-op → think MI →
intubate before ECG
● Bronchial rupture: crunching sound in sync with
heartbeat, respiratory acidosis, can also present with
hemothorax/PNA that recurs following thoracostomy
○ Patient can survive 30 mins after the trauma
● PPV in neonates:
○ HR < 100
○ Gasping
○ Apnea
● Medulloblastoma: features of ICP
● Craniopharyngioma: hyperprolactinemia, delayed growth,
diabetes insipidus, hypopituitarism
● Neonatal birth marks:
○ Congenital melanocytic nevus: will grow in
proportion to the child's growth

○ Infantile/strawberry hemangioma: rapid growth

followed by resolution by age 5

○ Congenital dermal melanocytosis: slowly fading

and resolved by adolescence

● Functional flat foot: depressed medial longitudinal arches

with heel eversion and forefoot abduction → reassurance
● Renal papillary necrosis
○ Symptoms:
■ Gross hematuria
■ No casts
■ Proteinuria
■ Pyuria
○ Causes:
■ Sickle cell
■ Acute pyelonephritis
■ NSAIDs
■ DM
● Most common causes of cirrhosis:
○ Chronic viral hepatitis
○ EtOH
○ Non-alcoholic steatohepatitis
■ Obese
■ Metabolic syndrome
:
 ■ T2DM
● Standard deviations and CIs:
○ 1 standard deviation from mean = 68%
○ 2 standard deviations from mean = 95%
○ 3 standard deviations from mean = 99.7%
● VEAL CHOP
○ Variable = cord compression
○ Early = head compression
○ Accelerations = okay
○ Decelerations = placental insufficiency
● Post-op atelectasis = elevated diaphragm with
opacification, respiratory alkalosis
● Hyperthyroidism in pregnancy:
○ 1st trimester: PTU
○ 2nd and 3rd trimester: methimazole
● Txt CAPNA with oral amox if CURB-65 is less than 1
● Beckwith-Wiedemann syndrome: abdominal US every 3
months until 8 years old to look for
neuroblastoma/nephroblastoma
● Short cervix = < 25 mm
● For variceal ppx, use nonspecific bb
● NF2:
○ Bilateral schwannoma
○ Meningioma
○ Ependymoma
○ Cataracts
● Children who are transitioning → consult multidisciplinary
team specialized in gender identity
● Recurrent UTI in child + vertical midline fold in perineum
without visible vaginal opening = labial adhesion → txt
with topical estrogen
● Indirect (DIR) congenital inguinal hernia: due to patent
processus vaginalis
○ Txt with surgery within 2 weeks of diagnosis
April 5th, 2025
● Maternal malnutrition: fetal head big and body small
● Swallowed magnets: if already in the bowel, inpatient
serial imaging every 4-6 hours
● Inhalation injury → immediate intubation
○ Biggest concern is airway compromise
● Treatment for ankylosing spondylosis:
○ First-line: NSAIDs
○ If NSAIDs fail to control pain after 2 months, next
step is etanercept + PT
● Morton neuroma: medial plantar nerve entrapment
presenting with neuropathic pain on palpation
○ Narrow footwear/heels
● Thoracic aortic rupture: left pleural effusion, depression of
L mainstem bronchus, eso deviation, hemothorax
● AUB and pelvic pain:
○ Polyp: usually less than 4 cm
○ Endo carcinoma: uniform endo thickening on US
(NOT A MASS), tamoxifen use
○ Leiomyosarcoma: post-menopausal, mass effect,
abdominal girth, irregular enlarged uterus,
tamoxifen use
■ US shows echogenic mass with central
cystic area, biopsy showed aplastic cells
and areas of necrosis
○ Adeno: enlarged globular uniform uterus,
asymmetric uterine thickening on US, not a mass
● HOCM:
○ Asymmetric LV wall thickening
○ Systolic anterior motion of the anterior mitral valve
○ Asymmetrical septal hypertrophy
● Low electrolytes = long QT
● Treatment of stuff:
○ Malignant hyperthermia = dantrolene
○ NMS = bromocriptine
○ Serotonin syndrome = cyproheptadine
● Burn wound sepsis vs. hypermetabolic state
○ Burn wound sepsis:
■ Use criteria
■ Leukocytosis
■ Hypothermia
:
 ■ Hypotension
■ Tender burn wounds with edematous
borders
○ Hypermetabolism:
■ Tachycardia
■ Tachypnea
■ Hypertension
■ Hyperthermia
● SERMs:
○ All cause DVTs***
○ Tamoxifen:
■ Antagonist: breast
■ Agonist: endometrium, bone
○ Raloxifene:
■ Antagonist: endometrium, breast
■ Agonist: bone
● Cushing ulcer: stress ulcer that occurs due to brain
injuries in response to increased ICP → vagal stimulation
→ increased gastric acid production → mucosal
ulceration
○ Can occur in hepatic enceph resulting from
acetaminophen overdose
● Patient with epidural hematoma with ICP → craniotomy
○ Additionally:
■ Head elevation
■ Hyperventilation
■ Mannitol or hypertonic saline
● Fontanelle closure:
○ Anterior: 18 months
○ Posterior: 2-3 months
● Sandpaper rash = GAS scarlett fever
● Papillary thyroid cancer: most common, punctate
calcifications
● HSV diagnosis:
○ Active, primary lesions → viral culture or RT-PCR
of vesicles
■ Patients do not seroconvert until after
primary infx
○ Patients who have a history of genital vesicles and
have had negative PCR/culture OR have a partner
with known HSV → serum antibody
● Lowest rate of Graves disease recurrence is with iodine
ablation
○ Cannot treat with partial thyroidectomy bc the
whole gland is overfunctioning
○ Total thyroidectomy is reserved for patients with
severe ophthalmopathy, etc.
● RTAs in infants:
○ Type 1: cannot secrete H+
■ Hypokalemia
■ Hyperchloremic met. acidosis
■ Urine pH greater than 5.5
○ Type 2: cannot reabsorb HCO3-
■ Hypokalemia
■ Hyperchloremic met. acidosis
■ Urine pH LESS than 5.5 because H+ is
secreted into the urine to correct acidosis
● Off label prescription is ok for drugs that are approved for
other things
● Telangiectasias can be caused by carcinoid syndrome
● LAD leads: I, aVL, V1-V4
● Pregnant patients with CAPNA and comorbitities like
asthma → hospitalize and treat with beta-lactam and
macrolide
● Skew follows direction of tail
● Muscarinic toxicity txt = atropine then pralidoxime
● RA can cause Baker cyst
● To rule out c-spine injury in a trauma patient, get cervical
spine CT (NOT X-RAY)
● Neonate crying and clenching extremities after
circumcision → pain → topical lidocaine
● chronic respiratory alkalosis, the expected HCO3- is
calculated by the formula 24 - [0.5 x (40 - pCO2)] +/- 3
● Superior gluteal nerve damage = hip drop
(Trendelenberg sign)
:
 ● After H. pylori treatment, confirm with urea breath test
● Egg allergy IS NOT CONTRAINDICATION TO FLU
VACCINE
● Ketoacidosis vs. DKA vs. postictal state:
○ Alcoholic ketoacidosis: normal glucose + HAGMA
+ ketones
○ DKA: high glucose + HAGMA + ketones
○ Post-ictal state: HAGMA + normal glucose + NO
KETONES
● Cardiac contusion → decreased contractility (cardiogenic
shock) and afib
● Leucovorin is a folic acid derivative and is administered
with MTX to prevent bone marrow suppression
● De Quervain tenosynovitis: pain over radial styloid and
positive Finkelstein test

● Treatment of hodgkin lymphoma is not LN resection →

start chemotherapy with ABVD
● Fused thalami = holoprosencephaly (cerebral
hemispheres do not divide)
● For kids with signs of sexual abuse, interview patient and
mother separately
● Polyarteritis nodosa:
○ Medium vessel: transmural inflammation of the
arterial wall
○ Multiple organ systems: nonspecific kidney,
cardiac, skin, joint, GI findings-- usually spares
lungs
○ Associated with hepatitis B and C
● Glomerulonephritis vs. minimal change gross findings:
○ GN presents with red or cola-colored urine and
milder edema compared to nephrotic syndrome (<
3.5g/day)
● Mammary candidiasis: treat with topical miconazole or
nystatin for mom and baby
● Dilated small bowel and microcolon in newborn who
hasn't passed stool → meconium ileus → gastrografin
enema
● CVID → increased risk of autoimmune disorders (like ITP,
AIHA, etc.)
● Botulism txt:
○ Infants: human IVIG
○ Adults: equine antitoxin
● Itching eyes = allergic conjunctivitis
○ Bacterial conjunctivitis: purulent discharge, eyelid
erythema and pain
● Natalizumab increased risk of progressive multifocal
leukoenceph
● CPR for 30 mins without ROSC → call it
● Z-line displaced above diaphragmatic hiatus = sliding
hiatal hernia
○ For asymptomatic patients, reassurance and f/u
● Brain mets: lung cancer
● Pancoast tumor usually bronchogenic carcinoma
:
 ● Decreased systolic BP = massive PE = poor prognosis
● Pregnant woman with syphilis and PCN allergy →
desensitization dose
● Meningitis bugs:
○ Gram negative diplococci: neisseria
meningococcal meningitis
■ Adrenal insufficiency
○ Gram negative coccobacili: H. flu
■ Hearing loss → give dex
○ Gram positive bacillus: listeria
■ Abscess
● First line for post-herpetic neuralgia: gabapentin
● Black liver → Dubin-Johnson
● Cerebral edema: give mannitol
● Idiopathic intracranial HTN: acetazolamide
● PAD: do surgery only if there is chronic limb-threatening
ischemia
○ Rest pain
○ Nonhealing lower extremity wounds
○ Gangrene for at least 2 weeks
● Febrile seizures due to herpangina → NSAIDs or APAP
● Thoracostomy: chest tube insertion
○ For a hemothorax, if the chest tube puts out more
than 1.5 L at placement or more than 200 ml/hr, go
to OR for thoracotomy
● Presumed biliary pancreatitis → abdominal US to look for
stones in the biliary and pancreatic duct
● Low PO2 post-op → ARDS → increase PEEP
● For all patients with RA, even if symptoms controlled with
NSAIDs, give MTX
● Septic pelvic thrombophlebitis: post-section fever that is
not resolved with abx and lower quadrant pain
● Minimal change: treat with steroids
● Viral myocarditis does not present with rash
○ If kid with CHF and rash, acute rheumatic fever
due to GAS infx
● Vaginal dryness while breastfeeding is normal because
prolactin inhibits GnRH → low estrogen
● Near-sighted = myopia → treat with concave lens
● Far-sighted = hyperopia → treat with convex
● Central cord syndrome: bilateral upper extremity
weakness with diminished pain and temperature
sensation after trauma in an elderly patient
○ Confirm with MRI with contrast
● Cooling measures:
○ Heat stroke: ice water immersion until 102.2F
○ Heat exhaustion: evaporative cooling
● Dupuytren contracture (palmar fibromatosis):
painless palmar nodules that prevent extension of
affected digits, usually multiple nodules on 4th and 5th
digits
● Tenosynovitis: painful palmar nodule that prevents
extension of fingers, usually single nodule
:
 ● Cardiac tamponade:
○ Nonspecific: tachycardia, tachypnea, low BP
○ More specific: narrow pulse pressure, pulsus
paradoxus, clear lungs
● Pulsus paradoxus:
○ Cardiac tamponade
○ Pericarditis
○ Asthma
○ OSA
○ Croup
● Needs abx for dental procedures:
○ Prior infective endocarditis
○ Unrepaired congenital cyanotic heart disease
○ Prosthetic valves
○ Cardiac transplant with valvulopathy
● Papillary muscle rupture is most likely ≥posteromedial
after MI of PDA
April 7th, 2025
● Wiskott-Aldrich can present with rectal bleeding and
purpura
● CO poisoning can present with lactic acidosis due to
tissue hypoxia
● Treatment of long QT syndrome:
○ Firstline: beta blocker
○ Medical failure or high risk: implantable defibrillator
● Thrombocytopenia in cirrhosis is due to hypersplenism
● Breastfeeding only decreases risk of pyloric stenosis
● Croup: subglottic larynx
● Laryngomalacia: supraglottic larynx
● Patient with ascites → para before surgery
● Positive likelihood ratio: sensitivity/(1-spec)
● Negative likelihood ratio: spec/(1-sens)
● Acute opioid OD will not have HCO3 compensation
● Can give partner 1 dose oral cefixime if partner dx with
gonorrhea
● + galactomannan = invasive aspergillosis → txt with
voriconazole
● Myxomatous valve degeneration: MVP
● Pathophys of HFrEF: chronic HTN increases afterload →
concentric hypertrophy → impaired myocardial relaxation
● PID empiric txt: ceftriaxone, doxy and metro
● Treating physician obtains informed consent
● S3: rapid left ventricular filling (increased LV filling
pressures)
● S4: decreased compliance of LV
● Asymptomatic bacteriuria during pregnancy:
○ amoxicillin/clavulanate
○ Cephalosporins (ceftriaxone, cefpodoxime,
cephalexin
○ Fosfomycin
○ Nitrofurantoin
● Do not give TMP-SMX in pregnancy
● For pheo management:
○ Give phenoxybenzamine before surgery
● Treatment of Barrett esophagus:
○ Low-grade dysplasia: endoscopic surveillance
after 6 months then yearly
○ High-grade dysplasia: endoscopic ablation
● Crohn’s strictures → stricturoplasty for bowel sparing
● Suspected inflammatory breast cancer → mammo + core
needle bx
● Cataracts: can cause darkened red reflex
○ Loss of vision
○ Halos around lights
○ Reduced night vision
○ Temporary near vision improvement
● Inguinal hernias:
○ Indirect: through the superficial inguinal ring VIA
the DEEP inguinal ring
■ LATERAL to inf. epigastric vessels
○ Direct: directly through transversalis fascia via
superficial inguinal ring
■ MEDIAL to inf. epigastric vessels
○ MDs Don’t Lie
■ Medial to IEVs → direct
:
 ■ Lateral to IEVs → indirect
○ Lice:
■ Head and body: pediculus humanus
■ Genitals: phthirus pubis
● Vertical c-section = contraindication to TOLAC
● Hyper IGM syndrome → defective CD40L
○ Mixed humoral and cell mediated deficits in
immunity
● ITP txt:
○ Mild bleeding: observation
○ Severe bleeding: steroids; if refractory, IVIG
● In IgA deficient patients, test for celiac with IgG
deamidated gliadin to avoid FN
● All individuals over 50 years old get 15 valent
pneumococcal and 23 valent next year
○ Or single 20 or 21 valent
● Common warts → topical salicylic acid
● Urogenital TB
● Kaposi sarcoma biopsy: spindle shaped cells, leukocyte
infiltration and angiogenesis
● Mercury poisoning: gingivitis, buccal inflammation,
anxiety, neuropathy
○ Txt with dimercaprol
● Complete malleolar fracture → ORIF to realign bone
● Bartonella vs sporothrix: sporothrix usually develops
lymphangitis along the lymphatic vessels whereas
bartonella is isolated suppurative LAD
● Pancytopenia with blood smear showing normocytic
normochromic cells = aplastic anemia → high EPO
● Pancytopenia with blood smear showing blasts = AML
→> high LDH
● Fibromuscular dysplasia:
○ Headaches
○ Lightheadedness
○ Tinnitus
○ High BP
○ Concurrent cervical and abdominal bruits
● Screen patients with PCOS for dyslipidemia and diabetes
○ Metabolic syndrome
● Posterior reversible encephalopathy syndrome: seizures,
headache, visual disturbance and AMS
○ Bilateral vasogenic edema in parietal and occipital
lobes
○ HTN emergency, preeclampsia, renal failure,
sepsis, immunosuppressive meds
● Symptoms of asthma but normal spirometry →
methacholine challenge or exercise challenge test
● Untreated cervical cancer can cause post-renal azotemia
via obstruction
● For nonseminoma testicular tumor → chemotherapy with
cisplatin, etoposide, bleomycin
● Non-seminomatous germ cell tumors: radioresistant and
aggressive
○ Embryonal carcinoma
○ Teratoma
○ Choriocarcinoma
○ Yolk-sac tumors
○ Mixed germ cell tumors
● Ulcer and decreased sensation = DM
○ PAD ulcers are PAINFUL
April 8th, 2025
NBME 11: 270
● Heat exhaustion can present with high temperature and
cool, clammy skin
● PPV and NPV differ with prevalence
○ Increased prevalence of disease, increased PPV
(higher chance that a positive test means you
have the disease)
○ Decreased prevalence, increased NPV (less
people with disease, more chance a negative test
means that you don't have the disease)
● Signs of PTX: supraclavicular fossa distension with
inspiration
● bCG false-positive PPD is usually within 5 years of
vaccination
:
 ● Strongest risk factor for in-hospital mortality in VTE
patients: age
● Newborn with bilious vomiting, pain on palpation of
abdomen → think volvulus → upper GI series
● Antidepressants without sexual dysfunction:
bupropion and mirtazapine (alpha-2
agonist/antagonist)
● Isolation precautions not necessary for mono
● Anemia, jaundice, daily fevers, elevated LDH + travel to
endemic area = malaria
● Aldosteronoma vs RAS
● Chickenpox vs. smallpox (vaccinia)
○ Smallpox is characterized by febrile prodromal
phase with vesicular rash at the same stage of
healing
● In male patient with PAD, HTN, CV risk factors who is 65-
75 years old, screen for AAA
○ Do not check for carotid stenosis unless
symptomatic or hx of stroke
● Blue sclera → think OI or Marfan
● UTI or pyelo in male infant less than 1 year old → renalo
US → voiding cysto
● Myocardial contusion: monitor with serial ECG
● In a patient who is hemodynamically stable in afib with a
normal ventricular rate, treat the underlying condition (ex.
dehydration)
● Aseptic meningitis: lymphocytes or monocytes
● Shunt fraction: fraction of blood that is not perfused
during a circulatory cycle
○ In a patient with CHF, pulmonary edema would
increase the shunt fraction since less blood will be
perfused (blocking alveolar-capillary interface with
fluid)
● VHL disease:
○ Hemangioblastomas: vascular tumors in the
retina, cerebellum, skin
○ Renal cell carcinoma
○ Pheo
○ Pancreatic cancers
● Any breast mass: imaging (don’t put it off for a follow up
visit)
○ Exception: adolescents who have a tender breast
mass a few days prior to menses → can evaluate
after period
● No spleen vaccines:
○ Meningococcal
○ Pneumococcal
○ Flu
○ Hib
● Patients who have any previous history of lung disease
(ex. COPD, emphysema, bronchiectasis) have increased
risk of opportunistic lung infx
○ Mycobacterium avium
○ Aspergillus
● Common causes for not being able to
amenorrhea/irregular menses:
○ Pregnancy
○ PCOS
○ Hypothyroidism
○ Hyperthyroidism
○ Hyperprolactinemia
○ Premature ovarian failure
○ GnRH suppression (anorexia)
○ Chromosomal abnormalities (in primary
amenorrhea, get a karyotype)
● Monophasic basal body temp means anovulation
● PNA treatment (bitch please remember this):
○ Community acquired PNA:
■ Inpatient:
● levo/moxifloxacin OR
● Ceftriaxone (3rd gen ceph) PLUS
azithromycin OR doxycycline
■ Healthy outpatient:
● Amoxicillin/augmentin OR
● Doxycycline OR
:
 ● Azithromycin
■ Comorbidities outpatient:
● Augmentin
● Levofloxacin
○ Hospital acquired PNA:
■ MRSA:
● Vanc
● Cefepime
■ Pseudomonas:
● pip/taz
○ Aspiration PNA: COVER ANAEROBES
■ Ampicillin-sulbactam
■ Carbapenems
■ Clindamycin
■ Levofloxacin
● Growth hormone deficiency vs constitutional growth
delay
○ GH deficiency:
■ Presents in infancy or childhood if
congenital
■ Acquired usually due to nonfunctional
pituitary tumor
■ Presents with severe growth delay
■ Bone age younger than chronological age
■ Crossing percentiles
■ Rapid decline in height for age curve
○ CGD:
■ Delayed pubertal development
■ Slow but CONSISTENT
■ Growth velocity
■ Bone age less than chronological age
■ Normal development and stature once at
puberty
○ Adenosine vs nuclear stress test:
■ Normal resting ECG and able to exercise →
exercise stress test
■ Normal resting ECG and cannot exercise →
adenosine stress test
■ Abnormal resting ECG → adenosine stress
test
○ Patient with penetrating trauma:
■ HD stable: FAST → CT if inconclusive
■ HD unstable: ex-lap
● Tachycardia (make sure to look at
the HR, not just BP)
● Hypotension
○ Bone tumors:
■ Osteochondroma: painless mass near a
joint, x-ray shows bony spur protruding from
the surface of the bone capped by cartilage
■ Chondroblastoma: low-grade joint pain and
swelling, x-ray shows a small, well-defined
lesion with sclerotic border at the epiphysis
of long bones
■ Ewing sarcoma: moth-eaten lytic lesions
and onion skin appearance of layered
neocortex/elevated periosteum
○ Genital cysts:
■ Vestibular gland cyst: fluctuant swelling
near the urethra due to blockage of Skene’s
glands
■ Bartholin gland cyst: fluctuant swelling near
posterior introitus
○ 6-month old with constipation since first week of
life: likely Hirschsprung disease
■ Lactose-intolerance or milk protein allergy
would present with bloating, abd pain,
diarrhea
■ Diagnosis:
● Rectal suction biopsy
● Barium enema
● Rectal manometry
○ Fever during transfusion → stop and check for
hemolysis
:
 ○ HIV prophylaxis during delivery even without
treatment during pregnancy: intrapartum
zidovudine
○ IIH treatment:
■ Acute: lumbar puncture
■ Outpatient: weightloss and acetazolamide
○ Adolescent girl with primary amenorrhea
■ Look at height
■ Karyotype
○ Turner syndrome: high LH/FSH, but no ovaries so
no E
■ Hypergonadotropic hypogonadism
○ 1-2 tubular adenomas → colonoscopy every 5-10
years
○ X-rays often do not show stress fractures → txt
with cast immobilization
■ Common in military or long-distance
runners
○ Tinea capitis can present with scattered papules
with alopecia
■ Can be caused by sharing hats
○ Asthma spirometry
■ FEV1: decreased
■ FVC: normal
■ Total lung capacity: increased
○ Dental prophylaxis: amoxicillin or macrolide
○ PJP: presents as diffuse bilateral infiltrates
○ Primary amenorrhea is not diagnosed until age ≥
15 with normal secondary sex characteristics (age
≥ 13 without)
○ IVDU with substernal chest pain and odynophagia
→ EGD to assess for esophagitis (candida likely
due to HIV from needle sharing)
■ Bacterial endo wont present with pain
swallowing
○ Risk factors for AML:
■ Chemo
■ Radiation
■ Myeloproliferative disorders
■ Down syndrome
○ Nitrofurantoin treats UTI but not pyelo
○ Valproate can cause leukopenia and
thrombocytopenia
○ Ciguatera poisoning: caused by eel, grouper,
barracuda, causes paresthesia, temperature
dysesthesia
○ Patient with ankle injury who can bear weight and
does not have pain with pressure on posterior
edge or tip of medial or lateral malleolus → no
imaging, PT and soft ankle brace
○ Free ventricular wall rupture → cardiac
tamponade, shock, hypotension
○ Chordae tendinae rupture: hypotension, JVD, low
O2 sat, new holosystolic murmur (new HP and
pulmonary edema)
○ Infliximab side effect: anemia → get CBC after
starting
○ Beta = probability of a type II error occurring (false
negative)
■ If beta is .2, there is a 20% chance that the
results are a false negative
○ Fibrosarcoma → CT chest and abd to look for
mets
○ Need to know risk of death in control group to
compare relative risk in experimental
○ Long term immunosuppression can cause a big
ass skin mass → prob a SCC
○ Investigators was to see if cerclage prevents
preterm labor. Women with short cervix are split up
into a cerclage group and bed rest group to see
which group has higher rates of preterm labor.
■ Exposures: cerclage and no cerclage
■ Outcome: preterm birth
■ Cohort study
:
 ○ Descriptive studies are case series, case reports,
cross-sectional
○ Ovarian cancer treatment: resection and chemo
○ Woman taking an OCP with HTN → d/c OCP
before prescribing HTN meds
○ Overflow incontinence can present with loss on
valsalva but with a high post-void residual
■ PVR of 150-300+ = overflow incontinence
■ Either due to neurogenic bladder, diabetic
neuropathy, or bladder outlet obstruction
○ Woman on HRT who has breakthrough bleeding
even with improper med adherence → endometrial
biopsy
April 9th, 2025
● Research in vulnerable populations: pregnant, neonates,
children, prisoners, intellectually disabled, economically
or educationally disadvantaged
● All patients with cirrhosis should be screened for HCC
with abd US every 6 months
○ Normal AFP with US findings of nodular liver with
atrophy = cirrhosis
● Epidermoid cyst vs lipoma
○ Epidermoid cyst: originates from layers of the skin,
nontender, firm, slow-growing nodules, overlying
skin cannot be pinched
○ Lipoma: rubbery, slow-growing mobile nodules,
skin overlying can be pinched
● Acute bilateral cervical LAD can result after viral URIs
○ Can last a week after along with mild pharyngeal
erythema, not concerning if patient feels well/ they
resolve within 1 month
○ Cough and coryza = viral URI
● Most common cause of distal symmetric polyneuropathy
with decreased DTRs is DM
○ Contrast with vitamin B12 deficiency, which
causes a spastic paresis with signs of anemia,
fatigue and gait ataxia
■ Paresthesia
■ Impaired proprioception
■ Loss of vibratory sense
■ Gait abnormalities
■ Spastic paresis
● Thymic sail sign: normal finding in neonates/peds
patients
○ Absence = DiGeorge syndrome

● Alcoholic patients with symptomatic hypocalcemia →

give Mg first
● IgA vasculitis:
○ Arthralgia
○ Mild GI symptoms
○ Purpura
○ +/- IgA nephritis → RPGN
○ Increased risk of intussusception
● Patient with UC and colon cancer: proctocolectomy,
rather than just hemicolectomy of lesion
● Hypothyroidism can cause a hoarse voice and
NONPITTING edema
● Osteoporosis pathophys: decreased osteoblast activity
relative to osteoclast activity
● Osteomalacia: decreased bone mineralization
:
 ● Avulsion fractures are common in PCL tears
● Painless lesion with painless LAD → sinus tracts
● Hawthorne effect: participants change behavior when
they know they're being observed
● Pygmalion effect (observer-expectancy bias):
investigator’s expectations influence outcomes
● SNRIs (duloxetine, venlafaxine, milnacipran) can txt
neuropathic pain
● Pure motor loss = lacunar stroke
○ Posterior limb of internal capsule
○ Lipohyalinosis of lenticulostriate arteries
● Melatonin only mildly improves sleep latency (time to fall
asleep)
● Functional trigger can be due to significant event or
injury/migraine, changes amplitude, frequency
distribution over time
● Perianal abscess vs hemorrhoids:
○ Perianal abscess is fluctuant
○ Hemorrhoids are firm perianal masses, treated
with rubber band ligation
● Trisomy 13 (Patau):
○ Aplasia cutis (punched out skin lesions)
○ Holoprosencephaly
○ Polydactyly
● Trisomy 18 (Edward):
○ Overlapping fingers
● When to give sodium bicarb for suspected TCA OD:
○ TCAs are known medication:
■ EKG, if QRS is > 100 ms or there is a
ventricular arrhythmia, give NaHCO3
○ Unknown medication list: urine assay for TCA level
● Restless leg syndrome txt:
○ Gabapentin
○ Check iron, administer if lower than 75
● Partial mole:
○ Small or normal uterus
○ hCG consistent with gestational age (ex. 100k at
8-10 weeks)
● Polycythemia vera: increased plasma volume and
increased RBC mass (total quantity of RBCs in
circulation)
● Peutz-Jeghers Syndrome:
○ AD
○ Hamartomatous polys
○ Mucocutaneous hyperpigmentation
○ Increased risk of CEO + pancreatic cancers
● Hereditary hemorrhagic telangiectasia:
○ AD
○ AV malformations in mucous membranes, skin, GI
tract, lungs, liver, brain, GU tract
● PML vs CNS lymphoma
○ PCNSL: CD4 < 100
○ PML: CD4 < 200
● Most common stone: calcium oxalate
● Cardiac cath patient with groin pain, pulsatile mass and
systolic bruit over swelling = femoral artery
pseudoaneurysm
○ Femoral AV fistula: mostly asymptomatic but leads
to limb edema, ischemia and heart failure few
months later
● Hypothyroidism can cause heavy, painful periods!!! Not
just amenorrhea
● Imagine of intracerebral hemorrhage vs SAH:
○ SAH: bleeding into subarachnoid space, diffuse
hypodensity within subarachnoid space
○ ICH: usually due to small penetrating artery in the
subcortical region resulting for HTN (causes
lipohyalinosis)
:
 ■ Hyperdense lesion surrounded by
hypodense edema

● After 6 months of successful antidepressant therapy:

○ Discontinue with taper if no risk factors
○ Maintenance: 1-3 years, maybe lifelong
■ 3 or more depressive episodes
■ Severe episodes (suicidal ideation)
■ Risk factors for recurrence
● Malpractice occurs if there is direct damage to the
patient-- up until that point it is misconduct
● Baby with Turner syndrome and diffuse swelling → due
to congenital lymphedema
● APML is treated with ATRA
● Warfarin reversal: PCC, FFP and vitamin K
○ Vitamin K aka phytonadione
● Apex of lung ascends 2.5 cm above the medial end of the
clavicle
● LITHIUM CAUSES DI NOT SIADH
● HIDA scan usually shows delayed or absent uptake of
tracer in patients with cholecystitis
● Erysipelas can present with lymphangitis
● Proximal LAD: V1-V6
● DiGeorge syndrome: SCID plus facial anomalies, heart
defects and hypocalcemia
● First line for teething syndrome: chilled rubber ring, then
APAP if unresponsive
○ Teething syndrome: irritability, SUBFEBRILE
temps, drooling, ear pulling, soft stools
● Viral pericarditis
● Hepatic hemangioma: <5 cm, observe
○ Women 30-50, homogenous, hyperechoic, well
circumscribed mass with arterial phase
enhancement
○ Don't biopsy
● Precision of a sample mean in estimating a population
mean is measured by standard error of the mean
● Delayed obstetric anal sphincter injury: absence of
perianal folds
● After LEEP, get HPV testing after 6 months for patients
25 or older (just pap if < 25)
● Preeclampsia without severe features before 34 weeks:
home BP monitoring and close follow-up
● Hematuria in smoker:
○ Cystoscopy
○ Renal US for intermediate risk
○ CT urography for high risk
● Nephrolithiasis treatment for > 10 mm stones:
○ Ureterorenoscopic stone removal
○ Lithotripsy
○ If signs of sepsis or infected hydronephrosis, stent
● Txt e. Coli septic arthritis with
cefepime/ceftriaxome/ceftaz
○ Don't need to covers MRSA if gram stain shows
gram - rods
● Central vs peripheral acute vestibular syndrome
● PEA: no pulse but activity on monitor → give epi
:
 ● Follicular thyroid carcinoma is characterized by
hematogenous spread and vascular invasion
● Orphan annie eye → papillary
● Wrap cut off finger in gauze damp with saline and put on
ice
○ Don't want it to dry out
April 12th, 2025
NBME 12: 258
● For neonates less than 22-23 (5ish months) weeks of
gestation, do not resuscitate
● For older people with OA, first like is NSAIDs
● Child with ovarian mass that’s symptomatic →
oophorectomy
○ Do not biopsy ovarian mass due to risk of seeding
● Primary ciliary dyskinesia: inability to clear mucus and
debris from airways
○ Recurrent upper and lower respiratory infx
○ Can occur without sinus inversus (Kartagener)
● Complement deficiency is typically deficiency of the
terminal complements, recurrent neisseria infections
● For nonadherent schizophrenia patients, change oral to
LAI
● If there is a patient that has suspected lung cancer who
presents with clubbing, arthralgias and periostosis of
tubular bones → hypertrophic osteoarthropathy 2/2 lung
adenocarcinoma
● Treatments for transfusion reactions:
○ Febrile nonhemolytic: stop transfusion, give
acetaminophen + leukoreduction for future
reactions
○ TRALI: stop transfusion + supportive (fluids, O2,
intubation if needed)
○ TACO: O2 and diuretics
○ Acute hemolytic: STOP transfusion
April 13th, 2025
● ALI can be due to atrial thrombus 2/2 afib that
embolizes to femoropopliteal artery
○ Dx with echo prior to onset of symptoms
○ ABI is not specific for cause of ALI-- just quantifies
how bad the ischemia is
○ ALI can also be caused by thrombosis 2/2
peripheral artery disease however it would be
preceded by claudication
● Features of ARDS:
○ Noncardiogenic pulmonary edema
○ V/Q mismatch (PaO2/FiO2 ≤ 300)
■ FiO2 is 20% on room air, plus 4% for every
liter of O2 on NC
○ Increased pulmonary artery pressure due to
hypoxic pulmonary vasoconstriction
○ Normal LA pressure and PCWP
● For an infant with macrocephaly, tense fontanelle and
sunset eye sign, perform US for diagnosis first
○ Can use US for any infant with anterior fontanelle
still open
● Fibroadenoma: follow up in 6 months for 1-2 years
● HDS and kidney lac → observation
● Diagnosis of acute compartment syndrome:
○ Needle manometry
● Hypergonadotropic hypogonadism:
○ Turner
○ Klinefelter
● Hemorrhoid treatment:
○ External (below dentate line): conservative
management
○ Internal (above dentate line):
■ Grade 1 and 2: not prolapse or reduce at
rest
● Conservative management
■ Grade 3: manually reducible
● Rubber band ligation
● Sclerotherapy
● Infrared coagulation
■ Grade 4: irreducible prolapse or thrombosis
● Arterial ligation
:
 ● Hemorrhoidectomy
● Hemorrhoidopexy
● Conservative management for hemorrhoids:
○ Stool softener
○ Sitz baths
○ Lifestyle mods
● Management of hyperthyroidism:
○ All symptomatic patients: propranolol
○ Indications for meth/PTU:
■ Most patients with get methimazole
(preferred over PTU due to potency and
duration)
■ Thyroid storm (PTU)
■ Contraindications for RAIA or surgery
■ Graves disease (likelihood of remission or
severe Graves ophthalmopathy)
○ Indications for RAIA:
■ Toxic multinodular goiter
■ Toxic adenoma
■ Failure of meth/PTU in Graves
○ Contraindication for RAIA:
■ Graves ophthalmopathy
■ Pregnancy
■ <5 years old
○ Indications for surgery:
■ Large goiters or obstructive symptoms
■ Graves with severe active Graves
ophthalmopathy
■ Planned pregnancy in next 6 months
● Most common cause of hypopituitarism in children =
craniopharyngioma
○ Pituitary adenoma is the wrong answer
● Miller-fisher syndrome: rare form of GBS due to
molecular mimicry between antigens of infectious agents
and GQ1b and GT1a of peripheral/central nerves (cross-
reactive immune response)
○ External ophthalmoplegia (CN3, 4 or 6)
○ Ataxia
■ + Romberg
○ Areflexia
○ anti-GQ1b antibodies
○ Treatment: plasmapheresis and IVIG
● TTP:
○ Fever
○ Anemia (MAHA)
○ Thrombocytopenia
○ Renal
○ Neurologic
■ Dizziness
■ Headache
■ Can have AMS but not always
● Most accurate measure of gestational age: crown-rump
length
● Orbitofrontal = prefrontal
● Treat chronic hypertension diagnosed in the first 20
weeks pregnancy with methyl dopa nifedipine labetalol or
hydralazine
○ Patience with blood pressure greater than 160
over 110 require urgent blood pressure control
with IV labetalol hydralazine or nifedipine
● For a patient with acute aortic regurgitation secondary to
infective endocarditis, perform mechanical valve
replacement of the aortic valve if the patient is less than
65 years of age and has no contraindications to lifelong
anticoagulation
● Lichen planus can result in chronic relapsing skin lesions
as well as mucosal lesions of the esophagus leading to
difficulty swallowing
● ALS is primarily diagnosed clinically but patients with
progressively worsening upper and lower motor neuron
degeneration should undergo electromyography to
confirm the diagnosis
○ diagnosis is confirmed if there's evidence of upper
motor neuron and lower motor neuron signs and
:
 greater than three regions in addition to clinical
findings
○ nerve conduction studies can be part of the
workup but they mostly rule out other causes of
the clinical features
● For postpartum hemorrhage and uterine atony
○ first-line treatment is IV oxytocin and bimanual
uterine massage
○ other uterotonic agents such as methrogen or
misoprostol and tranexamic acid should be
administered if first line therapies don't work
○ if bleeding does not stop, consider DIC or other
bleeding disorders
○ Use a balloon catheter or Intruder in packing to
decrease bleeding in preparation for surgical
procedures
○ surgical interventions like compression sutures or
hysterectomy should follow if conservative therapy
does not stop the Hemorrhage within 30 minutes
● Bed bugs versus scabies
○ scabies presents with erythematous papules and
purpose that worsens at night; typically mites
burrow and the flexor Services of wrists fingers
and intertriginous areas
■ treat with topical Permethrin
○ Bed bug bite present as predict arithmetics
papules that occur in linear series or clusters
■ treat with Pest Control
● An x-ray is required to confirm the diagnosis of
pneumonia
● Tarsal tunnel syndrome versus plantar fasciitis
● Achalasia due to Chagas disease typically occurs 10 to
20 years after the primary infection
● After a barium swallow showing achalasia and
esophageal manometry showing impaired relaxation of
the les, confirm the diagnosis with an upper endoscopy
which will rule out pseudoachalasia caused by
esophageal cancer
○ especially consider this and patience with the
history of weight loss or smoking
● COVID precautions = N95
● Forceps assisted delivery increases risk of facial nerve
palsy
● Mercaptoethane sulfonate = mesna
● Focal impaired awareness = temporal lobe spikes on
EEG
● Slow-wave and 3 Hz spikes on EEG = absence seizures
● Ascites protein levels > 2.5 occur in early Budd-Chiari
○ Portal HTN and ascites without EtoH use = Budd-
Chiari
● OCP and liver tumors:
○ Fibroadenoma: stop OCP
○ Focal nodular hyperplasia: no need to stop OCP,
f/u imaging in 3-6 months then none after
■ Liver mass with central scar
● Rapid clinical improvement after stroke and prodrome of
lightheadedness, dizziness and dyspnea = embolic
stroke 2/2 afib
● Appendicitis <18 y.o. is usually due to lymphoid
hyperplasia
● Allergic sinusitis:
○ Rhinorrhea
○ Itchy, watery eyes
○ Sneezing
○ Coughing
○ Sinus pain and pressure
○ Decreased hearing
○ Inflamed turbinates
○ Cobblestoning of posterior pharynx and upper
eyelids
○ Retracted injected TMs
● For a patient with suspected osteoporosis and concern
for hip fx, choose MRI of hip over DEXA
● Suspected chronic osteomyelitis → bone biopsy
:
 ○ X-ray can be screener, but bone bx will CONFIRM
dx
■ Pay attention to what the question is asking
(SNIM or confirmation of dx)
● Chronic OM → get X-ray, acute OM → MRI
● Aspergillus infx:
○ Invasive aspergillosis: severe PNA, septicemia,
extrapulmonary involvement, seen in
immunocompromised pts
○ Aspergilloma: opportunistic colonization of heavily
scarred lung usually from TB infx; cough,
hemoptysis, shifting mass in lung
○ Allergic bronchopulmonary aspergillosis:
hypersensitivity reaction caused by aspergillus,
commonly seen in patients with asthma or CF
■ Chronic cough
■ Dark sputum
■ Hemoptysis
■ Transitory pulmonary infiltrates
■ Peripheral eosinophilia
■ Bronchiectasis
■ Very high IgE
● Pityriasis rosea can follow infection
○ A large herald path with other smaller patches
○ Trunk and proximal extremities
○ Oval shaped patches and macules
○ Scaly
○ Rim of scale around leading edge
○ Mildly itchy (not to the extent of urticaria)
○ Contrast with drug reaction to PCN or sulfas:
■ Typically urticaria or erythema multiforme
● Vaccines for HIV patients:
○ At time of diagnosis, patients should receive
■ Pneumococcal 13 and 23 valent
■ Meningococcal
■ Hepatitis A
■ Hepatitis B
■ HPV
○ After 5 years, readminister PPSV23
○ At age 65, repeat PPSV23
● Patient with SBP might be afebrile but para is still
indicated in rapidly progressing ascites
○ If cell count >250, give abx
● If a patient has a DNI order unless there is acute,
reversible illness, intubate the patient in the setting of
acute illness to assess reversibility of illness
● 4 classes of 1st line anti-HTNs:
○ ACE inhibitors
○ ARBs
○ CCBs
○ Thiazides
● Seborrheic keratosis: no biopsy necessary
● Mortality in COPD is improved by smoking cessation and
home oxygen therapy
○ Do not need CPAP in COPD
● Confirm rotator cuff tear with MRI
● Splenectomy patient vaccines:
○ Meningococcal
○ Pneumococcal
○ Hib
● ALS vs transverse myelitis:
○ ALS is purely motor
○ Transverse myelitis presents with sensory, motor,
autonomic dysfunction of the bilateral lower
extremities below a specific spinal level
● For infected wound sites (traumatic injuries, other
contaminated wounds), leave wound open with wound
vac to drain underlying tissues to decrease SSI and heal
by delayed primary closure
● Scopolamine or glycopyrrolate can be used for terminally
ill patients with compromised swallowing or excess
secretions
● Pregnant patient with appendicitis → dx with US or MRI
(CT if MRI not available)
○ If these are not an option, pick laparoscopy
:
 ● Patients with drug-induced neutropenia, f/u in 1 week if
there are not signs of active infx
○ Neutropenia expected to resolve with d/c drug
● AIN:
○ Sterile pyuria
○ Rash
○ Low UOP
○ Eosinophils in urine
○ Recent ABX use
● Patient who is older and has a palpable breast mass with
- mammo and FNA → excision
○ MRI is only done for younger women with dense
breast tissue or to stage cancer
● Spontaneous perforation of the tympanic membrane can
occur in patients with otitis media; txt with cipro or
augmentin
○ Acute conductive hearing loss
○ bloody/purulent otorrhea
○ Alleviation of pain
● Patients with nerve palsy (ex. radial nerve), f/u with EMG
and nerve conduction studies
● SCC on the face classically presents as a non-healing
ulcer with everted edges, bleeds easily when touched
● Diaphragmatic rupture presents with chest pain,
decreased breath sounds, abd contents in thorax (bowel
sounds in chest)
○ Confirm dx with CT (X-ray alone is not enough)
○ Phrenic nerve injury is uncommon result of
trauma, presents with elevation of hemidiaphragm
but not herniation of bowel into thorax
● Acute otitis media = bulging red TM
● Otitis media with effusion = retracted opacified TM
● PPROM > 34 wks → induce
● Treatment for bacillary angiomatosis: macrolide alone or
doxycycline alone (even for immunocompromised)
● Treatment for mycobacterium avium: azithromycin +
ethambutol
● Treatment of acute cholangitis: biliary drainage via ERCP
● Zika:
○ Microcephaly
○ Spasticity
○ SNHL
○ Retinal mottling
● Terminal complement deficiency suspected → CH50
assay
● Increased PT and PTT with normal bleeding time →
issue with both intrinsic and extrinsic pathways or factor 2
(prothrombin), since it is common factor
○ Consider vitamin K deficiency 2/2 malabsorption
(factors 2, 7, 9, 10)
● RA+ syndromes:
○ Felty syndrome: RA + splenomegaly and
neutropenia
○ CAplan Syndrome: RA + pneumoconiosis
■ Coal miners
■ Asbestosis
■ Silicosis
● Symmetrical infarcts in watershed regions are likely due
to systemic hypotension
○ ACA-MCA:
■ Frontal lobe and superior parietal lobe
■ Proximal limb weakness
○ MCA-PCA:
■ Posterior parietal and occipital lobes
■ Bilateral cortical blindness
:
 ● Gram - rods in sputum culture of CAPNA → think
pseudomonas
○ Treat with cefepime and fluoroquinolones
● Common bugs:
○ Gram + diplococci:
■ Strep pneumo
■ Enterococcus
○ Gram - diplococci:
■ Neisseria spp.
○ Gram + cocci:
■ Staph
■ GAS
■ GBS (NOT diplo)
■ Bovis
○ Gram - coccobacilli
■ Haemophilus flu and ducreyi
○ Gram + rods:
■ Listeria
■ Diphtheria
■ Clostridium
○ Gram - rods:
■ Enterobacteriaceae:
● E. coli
● Klebs
● Proteus
● Salmonella
● Shigella
● Serratia
■ Non-enterobacteriaceae
● Pseudomonas
● Legionella
● Bordetella
○ Gram - curved rods
■ Campy
■ H. pylori
■ Vibrio

● Adolescent with nephrotic syndrome and hep B/C + →

membranous nephropathy
○ Subepithelial deposits on renal biopsy
● Complement levels are usually normal in MCD
● Hip dislocation is treated with emergency closed
reduction within 6 hours
● Suspicious lung nodule → pet scan
○ Can also proceed directly to biopsy for
intermediate or high risk
○ If metabolically active, biopsy
:
 ○ If inactive, monitor with f/u CT
● Most common lung cancer in smokers = squamous cell
carcinoma
● Anterior spinal artery syndrome: significant blood loss
can lead to ischemia of single anterior spinal artery (ex.
peripartum hemorrhage)
○ Flaccid paralysis (corticospinal)
○ Loss of DTRs (corticospinal)
○ Pain and temperature sensation loss bilaterally
(spinothalamic)
○ Hypotension due to autonomic fibers affected
○ Intact vibration and proprioception
● Suspected HL or NHL → excisional biopsy
○ Treatment is ABVD chemo, not LN excision
● ALL patients with nocturnal enuresis regardless if
asymptomatic get a urinalysis
● Suspected mets from KNOWN cancer?
○ Back → MRI with contrast
■ X-ray will not show epidural or spinal cord
involvement
■ Whole body X-rays only reserved for MM
and other purely lytic mets
○ Extremities → x-ray
● Older patient with back pain but no history of cancer?
○ Could get X-ray or straight to MRI
● Lithium-induced postural tremors:
○ Occurs in 25% of patients
○ Symmetric, nonprogressive, fine tremor in distal
ends of UEs
○ Reassurance or BBs for severe refractory tremor
● Bipolar treatment:
○ Acute mania:
■ Mild-moderate: monotherapy
● Lithium
● Valproate
● Atypical antipsychotic
■ Severe: combination therapy
● Mood stabilizer: lithium or valproate
PLUS
● Antipsychotic
■ Unresponsive to original treatment: adjust
mood stabilizer and/or antipsychotic
■ Refractory or severe mania: adjust
meds/ECT
■ Pregnancy:
○ Acute depression:
■ Atypical antipsychotics PLUS
■ Mood stabilizer
● Child with severe HUS → dialysis if AEIOU criteria are
met
○ NOT plasma exchange
● ARDS vs pulmonary contusion:
○ ARDS takes 12-36 hours to develop after trauma,
affects entire lung parenchyma
○ Contusion can result in symptoms within hour of
event and can localize to one lung lobe
● Toxic megacolon >10 cm → exlap
● Diagnosing acute leukemia → bone marrow bx
confirms dx
○ Blood smear is good for preliminary
● ITT preserves randomization
● New AV block in endocarditis = perivalvular abscess
● Ankylosing spondylitis: no changes in lung parenchyma,
so DLCO and RV are normal
● Most common causes of meningitis: enterovirus, HSV2,
echovirus
○ Would not have lyme meningitis without other
symptoms
● Penetrating duodenal ulcer can cause hepatic abscess
● Hydroxyurea prevents vasoocclusive crises in SCD but
not infx
● Young patient with emphysema → alpha1 antitrypsin def
→ increased risk of HCC
● Contraindication to oculocephalic reflex: c-spine injury
● Brainstem reflexes:
:
 ○ Corneal
○ Gag
○ Cough
○ Pupillary light
● Strokes
○ Cortical:
■ Contralateral focal motor symptoms
● ACA: leg
● MCA: face
● PCA: vision or language (for
dominant hemisphere)
■ Global gross motor weakness on one side
of body = brainstem strokes
○ Brainstem
■ 4 CN in each section (midbrain, pons,
medulla)
■ Forget about CN1 and 2
■ CNs that divide into 12 = midline
● CN3, 4, 6, 12
■ CNs that do not divide into 12 = lateral
● CN5, 7, 8, 9, 10
■ 4 motor syndromes are midline:
● Medial longitudinal fasciculus (eye
motor and lateral gaze)
● Motor tract of UMN (corticospinal
tract)
● Medial lemniscus (dorsal column,
vibration/proprioception)
● Motor nuclei of midline CNs
■ 4 sensory syndromes are side (lateral):
● Spinothalamic (pain and temp)
● Spinocerebellar (rapid alternating
movement)
● Sympathetic chain (horner
syndrome)
● Sensory CN nuclei
:
 ● Paget’s disease is treated with single dose IV
bisphosphonate
● SIADH treatment:
○ Severe symptoms or acute hyponatremia:
hypertonic saline in ICU
○ Nonsevere, nonacute hyponatremia: fluid
restriction to negative water balance
○ If water restriction fails or severe hyponatremia:
■ Vaptans (ADH receptor antagonists)
■ Demeclocycline
● Diabetes insipidus (arginine vasopressin disorders)
treatment
○ AVP deficiency (central DI):
■ Intranasal desmopressin: arginine
vasopressin (AVP aka ADH) analog
■ Chlorpropamide
○ AVP resistance (nephrogenic DI):
■ If drug induced, discontinue drug (lithium)
● If lithium-induced and patient
continues lithium therapy, give
amiloride
■ Thiazide diuretics
■ NSAIDs
:
 ● CSF leakage:
○ Rhinorrhea: basilar skull fracture involving the
anterior cranial fossa
■ Periorbital ecchymosis (racoon eyes)
○ Otorrhea: basilar skull fracture involving the
petrous temporal bone
■ Retroauricular ecchymosis (Battle sign)
● Diaphragmatic flattening increases WOB in COPD
● Rupture of pulmonary blebs in emphysema causes PTX
● Graves disease can present with nail clubbing or nail
changes
○ Thickened nails with distal white discoloration and
separation of nail plate
● Increase sweating, irregular menses, nonpitting plaques
on shins → Graves
○ Pretibial myxedema
● Immunocompromised patient with elevated beta-D-
glucan, respiratory distress, cough, interstitial infiltrates,
think PJP → BAL
● If fundoscopic exam shows proliferation of small vessels
around the disc and retinal vessels → neovascularization
2/2 diabetes
○ Treat with photocoagulation and VEGF inhibitors
(bevacizumab)
● Identification: an individual adapts their behavior to the
behavior of another person (ex. a person who grew up
abused by their parents grows up to abuse their own
children)
● For subdural hematomas, surgical evacuation is
necessitated if
○ There is evidence of neurologic deterioration
○ Hematoma is ≥ 10 mm
○ Midline shift ≥ 5 mm
● Conservative management with close observation and
serial CT scans can be considered for a small,
asymptomatic hematomas
● Recurrent PEs can lead to RV failure (might look like liver
disease)
○ JVD
○ BLLE edema
○ DOE
○ Clear lungs
○ Hepatic congestion
○ Ascites
○ + hepatojugular reflex
● Pure liver disease will not cause JVD (right heart failure
will cause JVD and 2/2 liver congestion)
● Bacterial conjunctivitis treatment: topical erythromycin or
TMP/polymyxin b
● Treat inclusion conjunctivitis due to chlamydia with
oral azithromycin
● Increased power, decreased risk of type 2 error (false
negative)
○ Power is 1 - beta
■ Beta = type 2 error
● Chloramphenicol can cause aplastic anemia months after
use
● Nocturnal enuresis = 5 years or older
● Dysphagia and heartburn refractory to PPIs, esophagus
showing circumferential, white lesions (like trachea) =
eosinophilic esophagitis
● Erysipelas/cellulitis with systemic symptoms → IV
cefazolin
● Erysipelas/cellulitis without systemic symptoms → oral
cephalexin or dicloxacillin
● Uncomplicated pyelo even with fever can be treated
outpatient with oral cipro
○ Complicated:
■ Male
■ Pregnant
■ Childhood recurrent UTI
■ Anatomical abnormalities like BPH
■ Immunocompromised
■ Catheterization or instrumentation
:
 ● Positive VDRL or RPR → FTSab → THEN treat with
PCN
● Patient with hemophilia and head trauma → give clotting
factors to prevent ICH
● Cerebral edema can occur during first 12 hours of DKA
txt
● Wells score
● AKI:
○ Glomerular filtration recovered after 2 weeks
○ Tubular reabsorption still impaired, increased urine
production and loss of electrolytes that are
reabsorbed by tubules
■ Potassium
■ Sodium
■ Magnesium
● Unprovoked 1st time seizure and ICH or other process
suspected → noncontrast CT head
● Chronic tachycardia can cause dilated cardiomyopathy
● PPSV23 administered 2 wks after splenectomy and
PPSV15 10 weeks after splenectomy
● DRESS syndrome:
○ Drug reaction with eosinophilia and systemic
symptoms
○ Occurs 2-8 weeks after drug exposure
○ Fever
○ LAD
○ Rash
○ Facial edema
○ Eosinophlia
● Peripheral artery disease: ABI < 0.9
○ Treatment:
■ Structured exercise
● Can improve claudication but not ABI
since exercise helps improve
collateral circulation
■ SAPT
■ Statin
Cilostazol for persistent symptoms
■ For patients with refractory symptoms or
chronic limb-threatening ischemia or ulcers,
revascularization therapy
● Wells score
● Peri-infarction pericarditis treatment: high dose aspirin
and acetaminophen
● Dressler syndrome treatment: high-dose aspirin (might
say NSAID), colchicine
● Open PTX: is HDS, txt with partially occlusive dressing
then chest tube after dx confirmed
○ Only needle decompression for tension
○ Open can become tension, but if patient is HDS do
dressing
● If COC fails for hirsutism after 6 mo. → spiro
● Unstable angina vs prinzmetal
○ Prinzmetal ECG will be normal within 30 mins
○ UA will not return to normal
○ Unstable brady → atropine before pacing
■ Unstable brady:
● Acute AMS
● Chest pain, symptoms of HF
● Hypotension
● Prospective cohort study: results are only generalizable
to population, not individual
● Acute stress disorder txt: trauma-focused therapy
● Abdominal compartment syndrome can be causes by
massive volume resuscitation 2/2 post op, hypovolemic
shock txt, severe burns
● HTN kidney injury: sclerosis in capillary tufts and hyaline
arteriolosclerosis
● Membranous nephropathy: thickening of glomerular
capillary loops and basal membrane
● MPGN: basement membrane thickening and splitting with
train-track appearance; C3 and IgG deposits
● Situational or reflex syncope: cough, swallowing,
urinating → parasympathetic hyperactivity → peripheral
vasodilation and bradycardia
:
 ● + orthostats = systolic BP decreased by 20 or diastolic
decreased by 10 within 3 mins
● Critically ill patients with intact GI system can get short
term NG tube feeds without contraindications-- can get
tube feeds on ventilator
○ Bowel obstruction
○ Intractable vomiting
○ HDUS
● Kidney stone shapes:
○ Bipyramidal, envelope: calcium oxalate

○ Wedge-shaped prisms: calcium phosphate

○ Rhomboid: uric acid

○ Hexagonal: cysteine

○ Coffin: struvite

● Post-transplant ppx: PJP and CMV

● Inability to actively extend distal phalanx after DIP injury
→ extensor digitorum tendon injury
○ Txt with stack split in hyperextension
● hyperIgM = normal lymphocyte count while Bruton will
have decreased lymphocytes
● Seborrheic keratosis ≠ seborrheic dermatitis
○ Use your brain
● OSA treatment:
○ If CPAP is not an option, can use mandibular
advancement device for mild-moderate OSA (5-15
apneic episodes/night)
○ Uvulopalatopharyngoplasty is second line for
moderate-severe OSA
● Patient with suspected BPH and increased Cr/BUN,
fatigue, nausea → renal US for hydronephrosis
● Primary CNS lymphoma: treat with MTX; cannot resect
● Whistling nasal sound a few months after nasal fracture =
nasal septal perforation probably 2/2 nasal septal
hematoma
● Dx acute prostatitis with urine culture
:
 ● Mom with red rash that started on face and arthralgia →
baby with murmur = PDA from rubella infx
○ Parvo also presents with rash starting on face and
arthralgia but not associated with murmur
● Atelectasis can be isolated to one lobe
● Squamous cell carcinoma: most common lung cancer in
smokers, presents with cavitary lesions MIMICKING TB
and hypercalcemia
● Marfan heart conditions:
○ Thoracic AA
○ MVP
○ AR
○ Aortic dissection
● Peritonsillar abscess treatment: I&D and IV amp-sul to
cover GAS, staph and anaerobes
● Mass BELOW inguinal ligament = femoral hernia due to
widening of femoral ring
● Torsades: goes from - to + through baseline
● Human bite wound:
○ 1. debride and clean
○ 2. Sterile dressing without closure
○ 3. Augmentin
○ 4. Tetanus ppx if not up to date
● Aortic dissection management:
○ Ascending (type A):
■ Signs of ascending dissection:
● Anterior chest pain
● Pulse deficit in upper extremities
● Neurologic deficits (carotid
involvement)
● Tamponade
● New AR
■ IV labetalol
■ Emergency surgery

○ Descending (type B):

■ Signs of descending dissection:
● Tearing back pain
● SOB
■ IV labetalol to systolic 90-120
■ Then nitroprusside
■ Conservative therapy if uncomplicated
■ Surgical intervention if
● Aortic rupture
● Renal failure
● Intestinal ischemia

● Diabetes med: if patient fails to control A1C to <7 with

non-insulin meds including GLP-1, add basal insulin
○ If still not controlled, use basal-bolus
○ Insulin is also for gestational diabetes
● Diabetes management:
○ Firstline is usually metformin for initial treatment
● Insulin:
○ Basal:
■ Glargine
■ Detemir
■ Degludec
○ Bolus: (they don't LAG)
:
 ■ Lispro
■ Aspart
■ Glulisine
● PPIs don't prevent aspiration PNA
● Severe hypothermia → internal rewarming
● SSRI uptitration can cause tremor
● Acute cervical lymphadenitis: clindamycin
● Meningitis in:
○ Immuncomprised
○ Focal neuro deficits
○ AMS
○ Seizure
■ Get head CT before LP BUT give abx
before anything else
■ Otherwise LP → abx
● Coarctation: narrowing of the descending aorta near the
ligamentum arteriosum
○ Most commonly distal to left subclavian where the
DA originates
○ Symptoms:
■ Brachial-femoral delay (weak femoral
pulses)
■ Cold feet, claudication, low BP in LEs
■ Differential in BP between UEs and LEs
● If original of left subclavian is
involved, BP in R arm is > BP in left
arm
● Supravalvular aortic stenosis
○ No BP differentials
○ Systolic murmur at 1st R intercostal space
○ Heart failure
● Hepatic abscess most commonly caused by cholangitis
● Dorsal midbrain injury → parinaud syndrome
○ Vertical gaze palsy
○ Pinealoma
● Trochlear nerve innervates superior oblique which turns
the eye down and in
○ Damage cause eyeball to go up and out
○ Compensatory head tilt to affected side
● Hodgkin lymphoma biopsy: Reed-Sternberg cells
● Sarcoidosis biopsy: epithelioid histiocytes and
multinucleated giant cells
○ Noncaseating granulomas
● LID LAG = thyrotoxicosis
○ Go with your gut
● Malignant hyperthermia happens intraoperatively
○ Muscle rigidity
● NMS: hyporeflexia
○ Leukocytosis
○ LFTs
○ Myoglobinuria
○ Lead-pipe rigidity
● SS: hyperreflexia, myoclonus
○ Benzos, cyproheptidine
● Thyrotoxicosis:
○ Fever
○ Tremor
○ Tachy
○ Afib
○ Diarrhea
○ confusion/delirium
○ Give BBs immediately then meth/PTU
● You can't do meth in the first trimester
● Girl MEN1 does not have a pheo be so for real
○ Pit
○ Pan: gastrinoma
○ Para: multiple HYPERechogenic structures in
ureteropelvic junction = stones,
HYPERCALCEMIA
● ARB = angiotensin receptor antagonist
○ Would have high ACE, just no response to it
NBME 13: 260
● ADHD → more likely to abuse substances
● Dental ppx is 1 dose amoxicillin morning of cleaning
● COPD exacerbation vs ACEinh cough:
:
 ○ COPD = SOB, progressive dyspnea, wheezing
● Patient with new incontinence, microscopic hematuria →
cystoscopy to evaluate bladder malignancy
○ Always rule out organic causes
● Pulmonary contusion vs. TRALI vs. ARDS:
○ Pulmonary contusion underlies injury location:
think about where the injury was
○ PC can develop over hours, ARDS up to a week
● ARDS: imaging will show displacement of fissures,
homogenous opacification of the collapse lobe
○ Ipsilateral diaphragm elevation
○ Loss of volume in affected side
● Measure free T4 to assess levo dose
● Adult patient with hyperglycemia and weight loss, think
T2DM before glucagonoma (unless signs of diarrhea and
dermatitis)
● Lithium can cause serotonin syndrome
● IHT = fit test for occult blood
● Look for a delta wave on an ECG of young patient with
palpitations
○ HOCM presents with murmur, exertional syncope
not palpitations, ECH shoes Q waves in I, aVL, II,
III, aVF
● Most important risk factor for breast cancer = age
● Likelihood ratio = TP/FP
● If the next step for an HIV patient is 1 drug ART, its the
wrong answer
● Acute loss of speech in child = assess for traumatic event
● Mutism vs speech pathology issue:
○ Mutism = understanding questions, responding
with nods, etc.
○ Speech pathology assesses receptive or
expressive issues
● SVC atherosclerosis can be asymptomatic
● Patient with epiglottitis and respiratory distress → OR for
intubation with direct laryngoscopy
● Patient with myelosuppression 2/2 chemo → give G-CSF
● Patients with severe spinal stenosis, severe and
progressive symptoms → laminectomy
● Milder symptoms = chronic leukemia
● If maternal parvo is suspected, get maternal serum-
specific IgG and IgM for parvo to see if she has been
infects
● For a patient who works with kids, wakes up with
redness, itchiness of one eye → think viral conjunctivitis
(no treatment other than supportive)
○ Allergic is super itchy, usually bilateral, typically
patients don't wake up with it, might be subacute
of seasonal
● Pregnant patient with symptoms of syphilis can be
treated empirically
● 6 months+ can get flu vax
● Frostbite injury can take hours to days to assess extent
of damage
● Carcinoid tumors can also secrete
○ Histamine
○ Bradykinin
○ Prostaglandins
■ Dx the same way with urine 5-HIAA
■ Same symptoms as normal carcinoid tumor
■ Flushing might not be related to
eating/drinking, doesnt rule out carcinoid
tumor
■ Can met to lungs, other places
● Regurgitation and no other good answers = Zenker
○ Even without other classic symptoms like halitosis
and gurgling
○ GERD/schatzki ring won't cause regurg
● Urge incontinence and microscopic hematuria →
cystoscopy
● If patient is trying to make a crazy decision, establish
capacity even if they have a power of attorney
○ They might be competent
● Single kidney with VUR and hydronephrosis → perc neph
before management of VUR to preserve kidney fx
:
 ● Trace urine protein in pregnant woman will be normal for
essential HTN
● Likelihood of isoimmunization is directly related to how
much blood the mom is exposed to (ex. Transfusion =
more likely)
● Decorate posturing can be from increased body temp in
heat stroke, not stroke, no need for CT head
● Get X-ray (amboss says MRI) for DDD if there are no red
flags (ex. Chronic back pain without reported trauma and
no FNDs, negative straight leg)
○ If there are signs of radiculopathy, myelopathy, or
cauda equina, get MRI with contrast
○ Acute radiculopathy like from lifting a heavy box =
don't need imaging
■ If persistent, get imaging
● Attrition bias: most people who drop out are from one
group and this skews the data
○ Avoid this with intention to treat analysis
● Adults can get intussusception
○ Lead point might be adhesion, malignancy,
stricture
○ Target on CT
● Laxative abuse:
○ Early: metabolic acidosis
○ Late: metabolic alkalosis (very chronic laxative
use)
■ Very low K causes H+ to move into cells →
alkalosis
● Patient with known IDA and restless legs → check ferritin
to make sure iron repletion is sufficient
○ Don't empirically txt with iron in patient without
diagnosis of IDA
● SBO with tender mass in inguinal canal → ex lap of
incarcerated hernia
● If white patch can’t be scraped off, still might be candida
○ Txt with fluconazole
○ Itra is for severe/refractory cases, more side
effects
● FTD can be treated with atypical antipsychotics
● Concern for insulinoma:
○ 72-hour fasting serum insulin and glucose
■ Patient is admitted, fasts up to 72 hours
with insulin, c-peptide and glucose level
measured every 4-6 hours
○ C-peptide concentration
○ Imaging
● Family history of hearing loss = worse prognosis of
hearing problems in a patient
○ Hereditary hearing loss can present at any point in
life
● Ovarian cysts can have intermittent torsion
● BRCA mutation testing is for patients with family history
of BC in young females or other red flags for BRCA
mutation
○ Increased risk of breast, ovarian, colon, pancreas
stomach, prostate (not endo)
● RA is symmetric
● If the reason for the error is not explicitly stated, perform
a root cause analysis
● Leakage of fluid from vagina weeks after abd surgery in
female = vesicovaginal fistula formation
● Monocular vision loss, elevated CRP/ESR, no significant
stenosis in carotids, fatigue, proximal muscle aching
(PMR) → temporal arteritis
○ Txt with pred
April 19th, 2025
● Down syndrome US features:
○ Nuchal translucency
○ Decreased PAPP-A
○ Clinodactyly
○ Hypoplastic nasal bone
● Diagnose post-cholecystectomy syndrome with ERCP
○ Increased ALP, LFTs
○ Dilated CBD > 10 mm
○ Might be due to residual gallstones
:
 ● Severe malaria can have pulmonary edema and renal
involvement
● If the fetal head it at 0 station and 2nd stage of labor is
prolonged, can do operative vaginal delivery over C-
section
● Hydatid cysts less than 5 cm do not need to be aspirated
● SCD vs polyneuropathy:
○ Do not pick SCD just because + Romberg
○ SCD patients will feel cut on the foot and have
intact sensation
○ SCD patients will have SPASTIC UMN signs
● Patient with epiglottitis in respiratory distress → BVM
until intubation in OR
○ Don't do a cric
○ Can BVM with drooling I guess
● Keloid management:
○ Removal after 6 months
○ CS injection if growing 4 weeks after injury
● Painful periods and heavy menses within 2 years of
menarche is due to immature HTGP index (aka
inadequate gonadotropin production)
● Flumazenil is only for accidental ingestion by children
(benzo naive patients), precipitates withdrawal
○ Can cause cerebellar signs like ataxia, nystagmus
● PBC:
○ Conjugated hyperbili
○ Increased ALP
○ Itching
○ Fatigue
○ Middle-aged woman
○ Hepatocellular damage (increased ALT/AST)
○ US showing mild echogenicity of liver
○ Sicca syndrome
○ Cutaneous xanthomas due to
hypercholesterolemia
● HIV test first-line in combination assay
● Rosacea triggers:
○ Alcohol
○ Hot weather
○ Exercise
● Treatment of nausea and vomiting in pregnancy:
○ Firstline: pyridoxine and doxylamine, lifestyle
mods, avoidance of triggers
○ Second-line: dimenhydrinate, diphenhydramine,
promethazine
○ Therapy failure: metoclopramide
● Antihypertensives for african american patients:
○ Firstline is chlorthalidone and DHP CCBs
● Todd paralysis can be a postictal focal paresis
● Patient with new unilateral pleural effusion → diagnostic
thoracentesis and fluid specimen
○ Transudative vs exudative
○ Tubes are usually reserved for recurrent effusions
and empyemas
● Febrile seizure is not contraindications for Dtap
○ Only uncontrolled seizure disorder, enceph,
severe allergic rxn
● Outliers do not affect mode
● Confirm hemochromatosis dx with genetic testing NOT
biopsy
● Type 4 RTA = aldosterone deficiency
○ ACE inhibitors
○ Diabetes
● Tay-sachs: beta-hexosaminidase
● Positive cross-arm adduction test = AC injury → X-ray
● HIV viral load > 1000 → c-section
● Leprosy treatment: rifampicin and dapsone
○ Mycobacterial infx
● Pelvic fractures with hemorrhage → immediate pelvic
stabilization with binder and volume resuscitation
● IgA deficiency are susceptible to recurrent mucosal infx
○ sinopulmonary (h. flu, s. pneumo)
○ GI tract (giardia)
○ ITP
:
 ● Pure motor stroke = lacunar stroke = posterior limb of
internal capsule due to occlusion of lenticulostriate artery
○ Most common cause is HTN
● Pure sensory stroke = lacunar stroke = posterolateral
thalamus
● Stable Boerhaave syndrome is managed conservatively
(NPO/PPIs/abx)
● Azathioprine/6-MP and allopurinol → pancytopenia due
to decreased metabolism of azathioprine
● Submucosal fibroids can cause infertility
● Delayed language development → audiology
● Severity of tetralogy of fallot = degree of RV outflow tract
obstruction
● LMWH is preferred for DVT prophylaxis post-op
○ Enoxaparin
○ Dalteparin
● Unfractionated heparin = CVT treatment
● Preeclampsia with severe features = 160/110 even
without other features
○ Treat with HLMN
● CT before LP in FAILS:
○ Focal neuro deficit
○ AMS
○ Immunocompromised/ICP elevation
○ Lesion in the brain or skin near LP site
○ Seizures
● Pure sensory neuropathy is a paraneoplastic syndrome
of small cell lung cancer
○ anti-Hu antibodies
● Lead-time bias: early detection before disease onset
might not actually improve survival
○ Time of disease onset might be the same
● Biopsy of kaposi vs bartonella
○ Both have vascular proliferation
○ Kaposi has spindle shaped cells
● Ulnar neuropathy:
○ Repetitive elbow flexion: cubital tunnel
○ Repetitive wrist extension (bikers): Guyon canal
● Well-differentiated thyroid cancer <1 cm without nodes,
mets, family history, head/neck radiation, older than 45
y.o. → lobectomy
● Intra-abdominal lymphomas can cause chylous ascites
○ High cell count
○ High TGs > 200
○ SAAG < 1.1
● Cutaneous anthrax vs. brown recluse
○ Anthrax = multiple painless eschars with
surrounding edema, start out as papules, LAD
○ Brown recluse: one necrotic ulcer, extremely
painful
● Diabetic autonomic neuropathy:
○ Constipation
○ Urinary retention
○ ED
○ Gastroparesis
○ Postural hypotension
○ Arrhythmias
● Chronic cough not responsive to benadryl, no symptoms
of GERD, next step is PFTs to evaluate for asthma
● 2-2 rule: if a person has 2 days of symptoms with 2
nighttime awakenings, they get albuterol
○ 3+ = ICS
○ Remember that it is inclusive
● Isolated, symmetric bruising on the dorsal forearms in an
elderly patient is more likely senile purpura without other
red flags
● Get x-ray after central line placement
● HBV infection treatment: supportive therapy due to high
spontaneous recovery rate
● HCV → interferon alpha
● DOAC is preferred for long-term AC in patients with DVT
○ Short term is heparins due to SQ inj
● Neonates with chlamydia trach = ORAL erythromycin due
to likelihood of PNA infx
:
 ● All pregnant patients with antiphospholipid syndrome get
aspirin and enoxaparin
○ Enoxaparin prevents thrombosis
○ Aspirin prevent preeclampsia
● Knee trauma = number 1 RF for baker cyst
● Hand motor innervation
● Osmolality formula
● Branchial cleft cyst: SCM, anterior triangle, doesn’t move
with tongue
● Thyroglossal duct cyst: midline, moves with tongue
● Treatment of orthostatic hypotension:
○ First-line: increased fluids and sodium, change
meds
○ Alpha-1 agonists: midodrine, phenylephrine
● HDS monomorphic vtach treatment:
○ Amio
○ Procainamide
○ Sotalol
● Hemorrhagic cystitis → - nitrites/leuk esterase
● Allergic conjunctivitis:
○ Ketotifen
● Schizoid vs. schizotypal:
○ Schizoid: isolation with INDIFFERENCE towards
social interaction
○ Schizotypal: magical thinking, weird dressing,
social ANXIETY, lack of social interaction
● Prosthetic joint infection: WBC > 1100
● Kidney transplant from live donor has better survival in
ESRD than dialysis
● OI vs EDS:
Feature Osteogenesis Ehlers-Danlos Syndrome
Imperfecta (OI) (EDS)
Pathogenesis Defective type I Defective collagen
collagen structure/processing (varies
synthesis (COL1A1, by type, e.g., COL3A1,
COL1A2 mutations) COL5A1)
Inheritance Mostly autosomal Varies: autosomal dominant
dominant or recessive, depending on
type
Main System Skeletal Connective tissue (skin,
Affected system (bone joints, vasculature)
fragility, fractures)
Clinical - Recurrent fractures - Joint
Hallmarks from minimal trauma hypermobility {NewLine} -
{NewLine} - Blue Hyperextensible
sclerae {NewLine} - skin {NewLine} - Easy
Hearing loss bruising {NewLine} - Poor
{NewLine} - wound healing {NewLine} -
Dentinogenesis Organ/vessel rupture (in
imperfecta vascular EDS)
{NewLine} - Joint
laxity
Skin Blue sclerae, Hyperelastic skin, atrophic
Findings sometimes thin skin scars,
easy bruising
Joint Joint hypermobility Generalized joint
Involvement (mild–moderate) hypermobility, frequent
subluxations
Other - Growth delay - Organ rupture (vascular
Features {NewLine} - Bowed EDS) {NewLine} -
limbs {NewLine} - Characteristic facial features
Micromelia in severe (vascular type)
forms
Diagnostics - Genetic testing - Clinical criteria (Beighton
{NewLine} - score for hypermobility)
Radiographs {NewLine} - Genetic testing
{NewLine} -
Collagen analysis
:
 Management Supportive: Supportive: physical therapy,
bisphosphonates, cardiovascular monitoring,
fracture care, surgical precautions
mobility aids
●Suspected mono with RUQ tenderness → get LFTs
●PJP can present with NORMAL X-ray
●EBV = posterior cervical LAD
●Asymptomatic patient with exposure to gc/chlamydia or
just 1 → txt with empiric doxy/cef
● Even for SAM in HOCM, give BBs
● Cafe au lait (brown macualr) spots → NF1 → ophtho
exam/ yearly MRI for optic glioma
● Ash-leaf spots (hypopigmented macules) → TSC →
cardiac tumors, seizures
UWSA2: 264
● Cardiogenic shock: increased SVR, decreased CO,
INCREASED LV preload (PCWP) due to congestion of
blood (decreased CO = more blood in the heart)
○ Cardiogenic = increased blood in heart so
increased CVP and PCWP (R and L preload)
○ Congestion
● Distributive shock = increased CO due to hyperdynamic
circulation
○ Decreased SVR
● LOC and extensor posturing = uncal herniation rather
than midbrain stroke
● Preop PT decreased risks of postop PNA in patients with
COPD, active smoking, obesity, OSA, CABG, > 65
● Thromboangiitis obliterans:
○ < 45 y.o
○ Active/recent smoking
○ Distal limb ischemia
○ Gangrene
○ Ulceration
○ Nonatherosclerotic occlusion or thrombus
○ Segmental occlusion of small/medium vessels on
angiography
● Bronchiectasis = permanent dilation and destruction of
airways
● Acute pyelo in pregnancy can present with ARDS
● Low calcium, high phos, EPS and weird neuro signs =
chronic hypoPTH leading to basal ganglia calcification
● Super preterm delivery is a risk for retained placenta
○ Can cause PPH
● Chemo-induced cardiomyopathy:
○ Doxorubicin = myocyte necrosis and fibrosis
○ Trastuzumab = myocardial stunning
● Penile cancer vs. syphilis:
○ Painless ulcer lasting months = cancer
○ Syphilis ulcer will resolve on its own in 3-6 weeks
even without txt
● Under age 6, children can have weird obsession with
death
● Diarrhea, vomiting → meningitis = listeria
●
AMBOSS Risk Factors
● Smoking is a risk for post-op complications like wound
healing and PNA
● CHF is a risk factor for periop complications
● Bipolar = genetics
● PAD patients are more likely to have an MI than ALI
● GERD: more likely to have stricture than
adenocarcinoma
● Esophageal adenocarcinoma: GERD and obesity
● Preexisting HTN → increased risk of PEC
● Local complications from catheterization:
○ Hematoma
■ Mass
■ No bruit
○ Pseudoaneurysm
■ Bulging pulsatile mass, no bruit
○ AV fistula
■ No mass
■ Continuous bruit
:
 ● Viral pleuritis (pleurisy) vs costochondritis:
○ Pleurisy: pain following a viral infection that can
radiate to shoulder
○ Costochondritis doesn’t radiate to shoulder
● Chalazion: blocked meibomian tear gland, eyelid
swelling, erythema, rubbery nodular lesion that can
resolve spontaneously
○ Hordeolum = stye, infx with staph aureus
○ Dacrocystitis = acute infx of lacrimal sac
● Low CRC screening → increase with P4P programs
● Pulmonary HTN due to left-sided heart failure is due to
pulmonary venous HTN
● HOCM: rapid and brisk carotid and peripheral pulses
○ AS is soft and delayed
● Hypercalcemia and hypokalemia → nephrogenic DI
○ Txt with thiazides, NSAIDs, amiloride
● LA changes occur in chronic MR; in MR due to inf MI,
LVEDV is increased

● Hemopneumothorax = chest tube

● PTX = needle
○ Anything with air DO NOT INTUBATE
● Testicle stuff:
○ Patent processus vaginalis = hydrocele and
indirect inguinal hernia
■ Hydrocele with transilluminate
○ Dilation of the pampiniform plexus = varicocele
: