USMLE Step 2CK Mnemonics Exam with Complete Solutions 2023

Axis deviation *RAD RALPH*, the *LAD* from *VILLA* hates *WOLVES* - ANSWER-*R*ight *A*xis *D*eviation *R*ight Ventricular Hypertrophy *A*nterolateral MI *L*eft *P*osterior *H*emiblock *L*eft *A*xis *D*eviation *V*entricular tachycardia *I*nferior myocardial infarction *L*eft ventriclular hypertrophy *L*eft *A*nterior hemiblock *Wolf*- Parkinson White syndrome can cause BOTH Left Bundle Branch Block *WiLLiam* - ANSWER-V1 = *W* QRS Pattern V6 = *M* QRS Pattern Right Bundle Branch Block *MaRRoW* - ANSWER-V1 = *M* QRS Pattern V6 = *W* QRS Pattern Management Options for Atrial Fibrillation *ABCD* - ANSWER-*A*nticoagulate *B*-blockers to control rate *C*ardiovert/ *C*alcium channel blockers *D*igoxin (in refractory cases CXR findings in CHF Diagnosis *ABCDE* - ANSWER-*A*lveolar edema ("bat wings") Kerley *B* lines (interstitial edema) *C*ardiomegaly *D*ilated prominent upper lobe vessels *E*ffusion (pleural) Acute CHF Management *LMNOP* - ANSWER-*L*asix (furosemide) *M*orphine *N*itrates *O*xygen *P*osition (sit upright) Treatment for MI Patient is *MOAN*ing *B*ig from MI - ANSWER-*M*orphine *O*xygen (to maintain saturations *A*SA + *A*dditional second antiplateley agent (NSTEMI) *N*itrates *B*-blockers Complications of MI *DARTH VADER* - ANSWER-*D*eath *A*rrhythmia *R*upture (ventricular wall, septum, or papillary muscle) *T*amponade *H*eart Failure *V*alvular Disease *A*neurysm of ventricle *D*ressler's syndrome *E*mboli (mural thrombosis) *R*ecurrence/ *R*einfarction/ *R*egurgitation (mitral) Treatment of HTN *ABCD* - ANSWER-*A*CEIs/*A*RBs *B*-blockers *C*CB *D*iuretics *typically thiazide Causes of Secondary HTN *CHAPS RECENT* - ANSWER-*C*ushing Syndrome *H*yperaldosteronism (Conn Syndrome) *A*ortic coarctation *P*heocromocytoma *S*tenosis of rental arteries *R*enal causes (renal artery stenosis, PKD) *E*ndocrine (Conn Syndrome, Cushing syndrome, hyperparathyroidism, pheochromocytoma) *C*oarctation of the aorta *E*strogen (OCP) *N*eurologic (ICP) *T*hyroid Disorder Causes of Pericarditis *CARDIAC RINDS* - ANSWER-*C*ollagen vascular disease *A*ortic dissection *R*adiation *D*rugs *I*nfections *A*cute renal failure *C*ardiac (MI) and *C*onnective tissue disease *I*njury *N*eoplasms *D*ressler Syndrome *S*urgery (postpericardiotomy syndrome) The 6 P's of Acute Ischemia - ANSWER-*P*ain *P*allor *P*aralysis *P*ulse Deficit *P*arasthesias *P*oikilothermia ("coldness") Causes of erythema nodosum *NODOSUM* - ANSWER-*NO* cause (60% idiopathic) *D*rugs: sulfa, NSAIDs, iodides *O*CPs *S*arcoidosis *U*lcerative Colitis/ Crohn Disease *M*icrobiology (TB, leprosy, histoplasmosis, chronic infection) Diabetes complications *KNIVES* - ANSWER-*K*idney (nephropathy) *N*europathy (peripheral neuropathy) *I*nfection (UTIs, pneumonia, soft-tissue infections, TB) *V*ascular (Coronary/cerebrovascular/ peripheral artery disease) *E*yes (cataracts, retinopathy) *S*kin lesions Criteria for Metabolic Syndrome *WEIGHHT* - ANSWER-*W*asit *E*xpanded *I*mpaired *G*lucose *H*ypertension *H*DL (decrease) *T*riglycerides (increase) Papillary Thyroid Carcinoma 6 P's - ANSWER-*P*apillae (branching) *P*alpable lymph nodes *P*upil nuclei (Orphan Annie nuclei) *P*sammoma bodies within lesions *P*ositive *P*rognosis Pages Disease of the Bone - Symptoms *PANICS* - ANSWER-*P*ain *A*rthralgia *N*erve compression/ *N*eural deafness *I*ncreased bone density *C*ardiac failure *S*kull involvement/ Sclerotic vertebra Cushing Syndrome - Symptoms *CUSHINGOID* - ANSWER-*C*ataracts *U*lcers *S*kin *H*irsutism, hypertension *I*nfections *N*ecrosis (femur head) *G*lycosuria *O*besity, osteoporosis *I*mmunosuppression *D*iavetes 5 P's of Pheochromocytoma - ANSWER-*P*ressure (BP) *P*ain (headache) *P*erspiration *P*alpitations *P*allor Men 1 affects - P Organs - ANSWER-*P*ancreas *P*ituitary *P*arathyroid The 4 D's of Malpractice - ANSWER-*D*uty *D*ereliction *D*amage *D*irect Cause *MD*s don't *LI*e - ANSWER-Medial to inferior epigastric vessels = Direct hernia Lateral to inferior epigastric vessels = Indirect hernia Antiphospholipid syndrome *CLOTS* - ANSWER-*C*oagulation defect *L*ivedo Reticularis *O*bstetric (recurrent miscarriages) *T*hrombocytopenia (decreased platelets) *S*LE (association) TTP Pentad *LMNOP* - ANSWER-*L*ow platelet count (thrombocytopenia) *M*icroangiopathic hemolytic anemia *N*eurologic changes *O*bsolete renal function *P*yrexia Thromboytopenia Differential Diagnosis *HIT CHINS* - ANSWER-*H*IT or *H*US *I*TP *T*TP or *T*reatment (medications *C*hemotherapy *H*erediatry (eg Wiskott-Aldrich Syndrome) *I*nfections (HIV, HCV) *N*eoplasm *S*plenomegaly Microcytic Anemia causes *IRON LAST* - ANSWER-*IRON* deficiency *L*ead poisoning *A*nemia of chronic disease *S*ideroblastic anemia *T*halassemia Hemolytic Anemia causes *MOM PASS* me the *GLUCOSE* - ANSWER-*M*icroangiopathic hemolytic anemia (TTP, HUS, DIC) *O*ther: malaria, hypersplenism *M*echanical hemolysis *P*aroxysmal nocturnal hemogolinuria *A*utoimmune anemia *S*ickle Cell Disease *S*pherocytosis *GLUOSE*-6PD Deficiency G6PD Deficiency causes of oxidative stress *S*ell *FAVA BEANS* in *INDIA* - ANSWER-*S*ulfa- drugs *FAVA BEANS* *I*nfections (most common cause) *N*itroduratoin *D*apsone *I*soniazid *A*ntimalarials (quinines) Multiple Myeloma - Clinical Features *CRAB* - ANSWER-hyper*C*alcemia *R*enal involvement *A*nemia *B*one lytic lesions/ *B*ack pain Causes of Secondary Eosinophilia *NAACP* - ANSWER-*N*eoplasm *A*llergies *A*sthma *C*ollagen vascular disease *P*arasites Pneumonia Hospitalization Criteria *CURB-65* - ANSWER-*C*onfusion *U*remia (BUN > 19) *R*espiratory rate (>30 breaths/min) *B*lood pressure *SBP < 90 mmHg or DBP < 60 mmHg) Age > *65* Common UTI Bugs *SEEKS PP* - ANSWER-*S*erratua *E*coli *E*nterobacter *K*lebsiella pneumonia *S*taphlococcus saprophyticus *P*seudomonas *P*roteus mirabilis Endocarditis *FROM JANE* - ANSWER-*F*ever *R*oth's spots *O*sler's nodes *M*urmur *J*aneway lesions *A*nemia *N*ail Hemorrhage *E*mboli *CREST* Syndrome - ANSWER-*C*alcinosis *R*aynayd phenomenon *E*sophageal dysmotility *S*clerodactyly *T*elangiectasias SLE Criteria *SOAP BRAIN MD* - ANSWER-*S*erositis (pleural or pericardial effusion) *O*ral Ulcers *A*rthritis (non deforming) *P*hotosensitivity *B*lood Disorder *R*enal Disorder *A*NA *I*mmunologic (anti-dsDNA, Smith proteins, antiphospholipid) *N*eurologic (lupus cerebritis, seizures) *M*alar Rash *D*iscoid Rash MCA stroke can cause *CHANG*es - ANSWER-*C*ontralateral paresis and sensory loss in the face and arm *H*emiparesis *A*phasia (dominant) *N*eglect (non-dominant) *G*aze preference toward the side of the lesion Contraindications to tPA therapy *SAMPLE STaGES* - ANSWER-*S*troke or head trauma within the last 3 months *A*nticoagulation with INR >1.7 or prolonged PTT *M*I in past 3 months *P*rior intracranial hemorrhage *L*ow platelet count (<100,000mm) *E*levated BP: Systolic >185mmHg or diastolic >110mmHg Major *S*urgery in the past 14 days *T*IA (mild symptoms of rapid improvement of symptoms within 6 months *G*I or urinary bleeding in the past 21 days or *G*lucose <50 *E*levated (>400mg/dL) or (<50mg/dL) *S*eizures present at onset of stroke Conditions associated with berry aneurysms that can *MAKE* an *SAH* more likely - ANSWER-*M*arfan syndrome *A*ortic coarctation *K*idney disease (autosomal dominant, polycystic) *E*hlers Danlos Syndrome *S*ickle cell anemia; *S*moking tobacco *A*therosclerosis *H*isotry (familial); *H*TN, *H*yperlipidemia The 4 A's of Guillain Barre - ANSWER-*A*cute inflammatory demyelinating polyradiculopathy *A*scending paralysis *A*utonomic neuropathy *A*lbuinocytologic dissociation (increased albumin in CSF) Decelerations OB/GYN *VEaL CHoP* - ANSWER-*V*ariable deceleration = *C*ord compression *E*arly deceleration = *H*ead compression *L*ate deceleration = *P*lacental insufficiency When performing a BPP - *T*est the *B*aby, *MAN* - ANSWER-Fetal *Tone* Fetal *Breathing Fetal *M*ovement *A*mniotic fluid volume *N*onstress test *7 W's* of Postpartum Fever, 10 days postdelivery - ANSWER-*W*omb (endomyometritis) *W*ind (atelectasis, pneumonia) *W*ater (UTI) *W*alk (DVT, pulmonary embolism) *W*ound (incision, episiotomy) *W*eaning (breast engorgement abscess, mastitis) *W*onder drugs (drug fever) Acute causes of pelvic pain *A ROPE* - ANSWER-*A*ppendicitis - periumbilical, RLQ pain, fever, nausea, vomiting *R*uptures ovarian cyst - recent strenuous physical activity, minor vaginal bleeding *O*varian torsion or abscess- torsion: severe unilateral pain (may be colicky), nausea, vomiting; abscess: gradual onset of fever, vaginal discharge, respectively *P*ID - gradual onset of fever, vaginal discharge *E*ctopic pregnancy - rule out with B-hCG test Causes of UTI without specific urogenital pathology *DIAPPERS* - ANSWER-*D*elirium/confusional state *I*nfection *A*tophic urethritis/vaginitis *P*harmaceutical *P*sychiatric causes (especially depression) *E*xcessive urinary output (hyperglycemia, hypercalcemia, CHF) *R*estricted mobility *S*tool impaction Tumor Lysis Syndrome *PUKE Calcium* - ANSWER-*Phosphorus *U*ric Acid *K* (potassium) *E*levated *Calcium* (decreased) Differential Diagnosis of Pediatric Limp *STARTSS HOTT* - ANSWER-*S*eptic joint *T*umor *A*vascular necrosis (Legg-Calve-Perthes) *R*A/ JIA *T*uberculosis *S*ickle Cell Disease *S*CFE *H*enoch - Schonelin Purpura *O*steomyelitis *T*rauma *T*oxic synovitis Medications for asthma exacerbations *ASTHMA* - ANSWER-*A*lbuterol *S*teroids *T*heophylline (rare) *H*umidified O2 *M*agnesium (severe exacerbations) *A*nticholinergics Sarcoid Features can be *GRUELING* - ANSWER-*G*ranulomas a*R*rhritis *U*veitis *E*rythema nodosum *L*ymphadenopathy *I*ntersitial fibrosis *N*egative TB Test *G*ammaglobulinemia Wells Criteria *SHIT PMH* - ANSWER-*S*ymptoms of DVT (3 points) *H*istory of DVT or pulmonary embolism (1.5 points) *I*mmobilization (>= 3 days) *T*achycardia with pulse > 100 (1.5 points) *P*ost-op (surgery in the previous four weeks) (1.5 points) *H*emoptysis (1 point) *M*alignancy (1 point) Treatment of Hyperkalemia *C BIG K* - ANSWER-*C*alcium chloride or gluconate (IV) *B*icarbonate, Beta-2 agonist *I*nsulin + *G*lucose *K*ayexalate (sodium polystyrene sulfonate Causes of hypercalcemia *CHIMPANZEES* - ANSWER-*C*alcium supplementation *H*yperparathyroidism/Hyperthyroidism *I*atrogenic (thiazides) *M*ilk-alkali syndrome *P*aget's disease *A*drenal insufficiency/acromegaly *N*eoplasm (breast, scc, mm) *Z*ollinger-Ellison syndrome (MEN 1) *E*xcess vitamin A *E*xcess vitamin D *S*arcoidosis Anion gap metabolic acidosis causes and treatment *MUDPILES* - ANSWER-*M*ethanol: fomepizole *U*remia _ Dialysis *D*KA: insulin, isotonic IV fluids, K+ repletion *P*araldehyde: Phenformin *I*ron, INH: GI lavage, charcoal (INH) *L*actic acidosis: correct underlying cause; if from ischemia then responds to repletion of circulating volumes *E*thylene glycol (antifreeze): Fomepizole *S*alicylates (late): IV fluids with added sodium bicarbonate to alkalinize urine Indications for urgent dialysis *AEIOU* - ANSWER-*A*cidosis *E*lectrolyte abnormalaties (Hyperkalemia etc) *I*ngestions (salicylates, methanol etc) *O*verload (fluid) *U*remic symptoms (Pericarditis, encephalopathy, bleeding, nausea, pruritus, myoclonus) Nephritic Syndrome *PHAROH* - ANSWER-*P*roteinuria *H*ematuria *A*zotemia *R*BC Cases *O*liguria *H*TN Differential Diagnosis Hematuria *I PEE RBCS* - ANSWER-*I*nfection (UTI) *P*olycystic Kidney Disease *E*xercise *E*xternal trauma *R*enal glomerular disease *B*enign prostatic hyperplasia *C*ancer, *C*ongenital anomalies/obstruction, *C*ysts, Hyper*C*alciuria, *C*rystals *S*tones, *S*ickle cell Causes of Pulseless Electrical activity (PEA) 6 *H*'s and 5 *T*'s - ANSWER-*H*yper/*H*ypokalaemia *H*ypoxia *H*ypothermia *H*ydrogen Ion *H*ypovolemia *H*ypoglycemia *T*amponade *T*ension Pneumothorax *T*hrombosis (coronary and pulmonary embolism) *T*ablets: drug overdose, ingestion Adolescent Drug Use Evaluation *HEADSS CRAFFT* - ANSWER-*H*ome *E*ducation *A*ctivities *D*rugs *S*exuality *S*uicidality C = Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using alcohol or drugs? R = Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in? A = Do you ever use alcohol or drugs while you are by yourself, or ALONE? F = Do you ever FORGET things you did while using alcohol or drugs? F = Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use? T = Have you ever gotten into TROUBLE while you were using alcohol or drugs?