The Next Best Step Vignettes (USMLE Step 2 CK) with complete solution

The Next Best Step Vignettes (USMLE Step 2 CK) with complete solution compare to previous chest x-ray - answerwhen you find a pulmonary nodule on chest x-ray Pulmonary angiogram (gold standard), but usually used in CT pulmonary angiography or CT with contrast - answermost accurate test in PE NO LIP Nitrates Oxygen Loops Ionotropic drugs (dobutamine) Positioning (blood pools in the legs) BNP > 400 - answertx acute CHF V/Q scan - answerif the patient cannot have CT angio then what imaging do you use to dx the PE CT chest/abdomen/pelvis and PET to look for mets - answernext best step after finding a brain tumor on MRI pleural:serum protein > 0.5 pleural:serum LDH > 0.6 pleural LDH > 2/3 serum LDH - answerLight's criteria for pleural effusion LABA's - answerwhat type of asthma treatment should never be used alone 1. clinical scenario - unable to count to 10, use of accessory muscles, etc 2. O2 < 50 3. CO2 > 50 * rule of 50's* - answerwhen should you intubate histoplasmosis - answerohio missipi cocciodes - answersouthwest US Wind - atelectasis Water - UTI Wound - wound infection Walking - DVT Wonder drugs -stuff we give them - answerW's of post-op fever broncheoalveolar carcinoma - answerrepeat lung infections in the same area in patient older than 40 years old CHADS2 > 2 CHF HTN (140/70) Age > 75 DM Stroke/tia previous (2 pts) - answerrequirement for anticoagulation in afib amiodorone - answertx for v tach with a pulse BB and CCB - answerrate control a fib < 48 hours - cardioversion > 48 hours - get TEE to look for intracardiac clot and then cardiovert/ otherwise rate control + anticoag - answertx of a fib 1. abdominal x-ray to look for pneumoperitoneum 2. if so, then immediate surgery, if no then move to contrast enema - a. if shows microcolon- meconium illeus- Gastriffin enem