Tiêu đề Step 2 CK Notes ✅

● neonatal acne aka neonatal cephalic pustulosis (new name): due to inflammatory reaction to Malassezia that colonizes skin; onset at age of 3 weeks ● USMLE Step 2 CK Notes¶ uuuuYuyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy yyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy yyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyuu uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuyyyyyyyyyyyyyyyyyy yyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyuyyyuuuuuuyyyyyuyyy yuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuyy yyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy Things to add to memory notebook: post-op fevers genital ulcer ddxg prevention cranial nerve + eye reflexes!! Hkkj CURB 65, WELLS intrinsic vs extrinsic coag pathway cortisol tests: late night salivary vs. overnight low-dose dexa vs. 24 hour urinary (no AM) S3/S4 gallops: S3 dCMP burn = LR (bc closer to physio levels of electrolytes) ARMD = central vision loss first reflexes - little rhyme AR (early dia) murmur: if due to aortic root dilation, best heard over RSB; if valvular, LSB FA page with all the autoantibodies breast cancer: inflammatory and infiltrating ductal both cause skin dimpling, but inflamm = RED and diffusely warm acne: comedonal = salicylic acid // inflammatory and nodular/cystic = benzoyl peroxide - topical retinoids work for all three
● neonatal acne aka neonatal cephalic pustulosis (new name): due to inflammatory reaction to Malassezia that colonizes skin; onset at age of 3 weeks rashes: syphilis includes palms/soles // staphylococcal toxic shock syndrome: maculopapular rash affecting the palms/soles - Rubella: cephalocaudal spread - Coxsackie A - hand/foot/mouth: involves palms and soles - 3 major infectious causes of rash over the palms and soles can be remembered with CaRS (Coxsackie A, Rickettsia Rickettsii (Rocky Mountain Spotted Fever) and Syphilis) CN locations (pons midbrain medulla) postop fever: nonhemolytic febrile transfusion rxn murmurs: - first right IC space: supravalvular AS with palpable thrill in supraclavicular notch - RUSB: AS (often heard with S4, due to atrial kick against stiff, ht. ventricle) tetanus: the ONLY person who needs TIG is if the pt hasn’t had 3 toxoid doses and its dirty - childhood series is the 3-dose - give tetanus toxoid (Tdap) if haven’t had it in 10 years (or 5 if dirty) ovary: testosterone // adrenal: DHEAS tremor Hz: 4-6 = parkinsons (10 letters) ¶ MyG vs the Lambert Eaton HIV prophylaxis at CD counts migraine acute vs chronic treatment (prophylaxis = BB, acute = triptan -_- Things to review: NNT hep B titers heart maneuvers emergency protocols: STEMI, AHF, AECOPD kidney stones (sketchy) ABO incompatibility (and blood group of offspring given mom/dad’s) transfusion reactions aldo-to-plasma renin ratio T3 to T4, free THs sketchy breast cancer which rash spares palms/soles
● neonatal acne aka neonatal cephalic pustulosis (new name): due to inflammatory reaction to Malassezia that colonizes skin; onset at age of 3 weeks hypotension: orthostatic (vasc. tone) vs vasovagal (incr. parasymp, decor. symp) vs hypersensitive (incr. baroreceptor activity) Values: specific gravity: low if <1.006 microalbuminuria: 30-300 mg/g (urine albumin/creatinine ratio) DTR, muscle strengths EF: >50-55% bladder volume in AUR (male): >300 ml urine sodium: <40 is low, >40 is high amniotic fluid index normal JVP 6-8 cm H20 (Amboss: anything higher than 4 is elevated) reflexes: 2+ = normal; 3+ may or may not be normal (very brisk) adequate contractions: average of 200 Montevideo units over a 10 min span kidney length... 10-12 cm ● Gestational asthma: look for a history of previous/poorly controlled/severe asthma ○ Ddx from dyspnea of pregnancy: that ONLY has shortness of breath (no chest tightness, no cough), and it’s not intermittent or diurnal ● Vitamin D deficiency: even if a patient lives on a farm, that’s only HALF of the daily requirement of vit D → the rest is from dairy, animal-derived product thus vegans are at increased risk of osteoporosis ○ The more north you go, the less sun you have ○ Veganism increases risk of Vit B12, IRON, calcium and Vit D (iron bc leafy green iron content isn’t enough for menstruating women or growing children), especially if pt doesn’t consume processed foods ● Diabetic foot ulcer is due to three things: motor (atrophy of intrinsic foot muscles → clawing of the toes and redistribution of pressure, sensory (doesn’t sense trauma) and autonomic (decreased blood flow, sweating) neuropathy ● Large ears AND large testes are seen in Fragile X (elongated face, ADHD, behavioral problems) BIOSTATISTICS & Ethics & Behavioral/Social ● False positive rate: start thinking of FPR as the complement of specificity → 1-specificity ● Positive predictive value: the percent of all with a positive test who DO have the disease ○ 99% of people with SCD had the disease thus PPV = 99%
● neonatal acne aka neonatal cephalic pustulosis (new name): due to inflammatory reaction to Malassezia that colonizes skin; onset at age of 3 weeks ○ Sensitivity: the people with the disease for which the test is positive ○ Predictive values depend on disease prevalence → the more prevalent, the higher the PPV ● Hazard ratio: hazard rate of an event/hazard rate of control ss than 1: means that the treatment group has a lower event rate ○ if greater than 1: the treatment group has a higher event rate ● Neyman bias aka late-look bias: when a cross sectional study cannot estimate the prevalence of SEVERE chronic conditions bc they are rapidly fatal ● Confidence interval with greater confidence level (like going from 90→95% for the same set of data) makes the CI wider ● Normal distribution: 68-95-99.7 ○ ex: 68% of adults lie within 1SD of height (64.5 +/- 2.5) thus 62-67 ○ Percentile is the value in a normal distribution that has a specific percentage of observations below it ● per-protocol analysis: excludes dropouts (includes only those who strictly adhered to, completed the protocol) ○ issue with this is that it misrepresents the effect of the intervention by overestimating ○ contrast with intention-to-treat analysis: initial allocation → more conservative estimate, but this is more close to real-life ● run chart: longitudinal graph, tracks a process performance outcome (like pt no-show rates) over time ○ shows performance variations and trends, and can be used to assess how effective a quality ○ improvement intervention is (compare pre- and post-intervention) ○ trend = same direction of change for 5+ consecutive points ● type I vs type II error: if you DOUBLE the control, you get a larger sample size, so greater power, so less type II error ○ and a larger type I error ● linear regression: best stats tool to describe the association between the explanatory and outcome variables ● gotta start thinking of variables as either qualitative (categorical) or quantitative, and as dependent vs independent (so ‘outcome’ is dependent on explanatory variable (independent)) ○ ● preop verification (time-out) should INVOLVE the patient (or a surrogate) ● if given a problem with accuracy/precision, don’t just eyeball: ○ estimate the accuracy by using a 5% reference value → find lower and upper cutoffs ● bivariate* = unadjusted analysis, and multivariate* = adjusted for age, sex, duration of CPB = this means that the multivariate study accounted for potential confounds