MedC Medical LibraryOpen in app
    General•Medically reviewed

    Nasser Step 2 Notes

    My own Step 2 notes

    2 views1 likes1 sectionsReviewed 19 Jul 2026 · Mohamed Nasser
    01All Notes
    • Cluster headache → Tx → 100% O2 #first line
    • Secondary amenorrhea + Depovera injections → Evaluate for pregnancy (the injection takes 2 to 3 months then wanes)
    • Cervical spine imaging indications → If
      • High-energy mechanism of injury
      • One of the following
        • Neurological deficit
        • Altered mental status
        • Spinal tenderness
        • Distracting injury
        • Intoxication
    • → CT scan
    • Blunt trauma + single vertebral fracture → Image the entire spine (CT)
    • Tumor lysis syndrome → Inceases PO4, K, Uric acid but DECREASES CALCIUM
    • Lateral Epicondylitis → Pain with passive wrist flexion or resisted extension
    • Acute Asthma exacerbations → Tx → - B2 agonists - Anticholinergic -Early steroids
    • Candidial vulvovaginitis → Norma PH (3.8-4.5)
    • Fibromyalgia → Tx → Aerobic exercise + good sleep hygiene → Then TCA #
    • GBS →
      • Preceded by → Campylobacter, CMV, EBV, HIV
      • Dx → Nerve conduction studies
      • Tx → Supportive, IVIG and plasma exchange
    • Lung abscess → Tx → Empiric Abs ⇒ Ampicillin-Sulbactam / Piparcillin-Tazobactam / Carbapenem
    • Clinical cues to Renovascular disease
      • Resistent HTN (despite 3-drug regimen)
      • Malignant HTN (with end-organ damage)
      • Onset of severe HTN (>180/120) after 55 age
      • Severe HTN with diffuse atherosclerosis
      • Recurrent flash Pulmonary Edema
    • Upper Extremity BP discrepancy could be due to atherosclerosis
    • Alport syndrome (X-linked) → Can’t pee, can’t see, can’t hear a bee
      • Nephropathy → Hematuria, ↑ CR
      • Bilateral SNHL
      • Anterior lenticonus
      • Splitting of GBM
    • Unstable moods, recurrent suicidal ideation, impulsivity, intense anger, chaotic interpersonal relationships → BPD → Tx → Psychotherapy with Dialectal behavioural therapy
    • If patient reluctant to suicide the risk assessment → empathetic, validating and non-threatening approach with open-ended questions
    • Chorioretinitis → Broad-spectrum Abs & Delivery (labor induction)
    • Mature Cystic Teratoma (Dermoid cyst) → US: Hyperechoic nodules with calcifications
    • Pneumothorax → Distended Neck veins due to superior vena cava compression
    • Diaper rash →
      • Spares skin folds ⇒ Irritant contant
      • Involves skin folds ⇒ Candidal superinfection
    • Patients with colon cancer → have increased risk of clostridium septicum (tumor cells increase anaerobic glycolysis → Acidic environments → Germination of spores)
    • Candidemia → endophthalmitis
    • Leukocoria → white pupilary reflex → Evaluate for Retinoblastoma
    • When there is only 1 safe, reasonable TTT with clear superior evidence → Directive counseling
    • Genetic testing in children should consider the best interest of the child
    • Screening for osteoporosis →
      • All women => 65 years
      • Women < 65 with risk factors
    • Retropharyngeal abscess → Danger zone → Acute necrotizing mediastinitis
    • Neuroleptic malignant syndrome → As antipsychotics decrease central dopaminergic activity → Autonomic dysregulation + Hyperthermia
    • Insulin resistance → NAFLD → ↑ peripheral lipolysis
    • DM → Damages JGA → ↓ renin → ↓ Aldosternone → RTA 4
    • Tourette → Tx
      • Anti-dopaminergic agents/ ⍺2-agonists
      • Tetrabenazine (dopamine depleter)
      • Antipsychotics
    • Implicit bias → Assess, encourage awareness (debrief), promote meta cognition
    • Meningioma →
      • Appearance: homogenous contrast enhancing, extra axial dural mass
      • Mx →
        • Small, asymptomatic → Observation
        • Large, symptomatic → Surgery
        • Unresctable → Radiation
    • 18 months → Walks easily
    • Polyuria → = urine output > 3L → Measure specific gravity
      • Dilute urine → Water diuresis
      • Concentrated urine → Osmotic diuresis
    • DI → ↑ during pregnancy
    • SCD → Pregnancy ↑ vasoocclusive pain episodes
      • Tx → Aggressive pain control & IV hydration
    • Cervical facet dislocation → Radiculopathy of the corresponding nerve root → most common C5/C6 and C6/C7
    • Over/under-reporting of exposure due to social stigmatization → Reporting bias
    • Camplyobacter → Fever, abdominal pain, diarrhea and PSEUDOAPPENDICITIS (RLQ pain due to iliocecitits)
    • Hemobilia → Bleeding into the biliary tract → complication of hepatic/biliopancreatic procedures → RUQ pain, jaundice, upper GI bleeding
    • Hemorrhagic shock → 1:1:1 FFB:PRBCs:Platelets (to reduce coagulopathy)
    • Slowly expanding, pruritic rash, annular, raised border, central clearing → Tinea Corporis
    • Cocaine → Diffuse Alveolar Hemorrhage
    • REM Sleep behavior disorder → Late night, awake easily, oriented & alert
    • Neurogenic shock → Interruption of descending sympathetic fibers → Unopposed parasympathetic action
    • Sarcoidosis in GI → HSM & ↑ LFTs (mixed)
    • DM Type 1 → Prior to exercise patient should ↑ carbohydrates intake and ↓ Basal & Bolus Insulin to prevent hypoglycemia
    • Tinea pedis → RF for cellulitis
    • Pronator drift → UMNL
    • MS → ≥ 2 DIT & ≥ 2 DIS
    • BPH → May lead to obstructive uropathy → Slowly rising Creatinine level → Hydronephrosis
    • Osteoid osteoma → May arise in spine, worse at night, unrelated to physical exercise
    • Cholangitis → Tx →
      • Aggressive IV hydration
      • Abs
      • ERCP → To relieve obstruction
    • Gall stone pancreatitis → Pancreatitis + Choledcholithiasis
    • Secondary Spontaneous Pneumothorax → Should be suspected in patients with underlying lung disease
    • Kawasaki → ↑ Platelets, ↑ WBCs, ↑ Acute phase reactants, ↑LFTs + sterile pyuria
    • Inflammatory back pain → gradual onset, young age, worse with rest and improves by activity
      • Suggests spondyloarthropathies (AS, Psoriatic arthritis, IBS-related, reactive)
      • Affects the sites of ligaments insertion (enthesitis)
    • Candidal endophthalmitis → Unilateral floaters, progressive vision loss, pain may occur later, fever may be absent
      • Common in patients with central venous cathetrization
    • Liver Transplantation → Infections are a major cause of morbidity
      • < 1 month → Bacterial causes
      • 1-6 months → Opportunistic infections (due to high level of immunosuppresion)
      • 6 months → Community acquired pathogens (At higher rate)
    • BCS → re-excision if positive margins
    • Uni-cameral bone cyst → simple cyst, fulid-filled, in long bone metaphysis in skeletally immature children
    • Succinylcholine → Hyperkalemia
    • Oxytocin → hyponatremia → Seizures
    • Child + Bone pain + Pancytopenia → ALL
    • Depression is common in parkinson disease
    • Chronic tophaceous gout → uric acid crystals in tissues → Chalky white appearnace
    • Transient synovitis → Self-limited joint pain after Viral URI → Common cause of hip pain in children
    • Diverticulitis → Abscess > 4 cm → Percutaneous drainage + IV ABs
    • Panic disorder → recurrent unexpected attacks with constant worry
    • PCOS → Tx → Weight loss +
      • For bleeding → COC
      • For infertility → Letrozole or Clomiphene
    • Review of medications should be prioritized in evaluating new onset or worsening memory impairment
      • Anti-cholinergic drugs are strongly associated with risk of cognitive impairment esp. in elderly
    • TSS → Fever, hypotension, maculopapular rash involving palms & soles with desquamation
    • HUS → Hemolytic anemia, thrombocytopenia, AKI
    • Ventilator-associated penumonia → ≥ 48 hours after intubation → C/P:
      • New pulmonary infiltrates
      • ↑ Respiratory secretions
      • Worsening respiratory status
      • Signs of systemic infection
    • Perivalvular abscess → in 30%-40% of patients with Aortic valve IE → Should be suspected if
      • Persistent bacteremia
    • or
      • conduction abnormalities
    • Aortic Regurge →
      • Valvular → Left sternal border
      • Aortic root → Right sternal border
    • PECARN rules for high-risk fractures
      • Severe mechanism of injury
      • Altered mental status
      • Loss of conciousness
      • Vomiting, severe headache
      • Signs of basilar fracture
    • → CT without contrast
    • AOM → RFs
      • Age < 2 years
      • Smoke exposure
      • Day care
      • Lack of breast feeding
    • Ear pain may present as: irritability, poor sleep/feeding
    • In the absence of any clear provoking factors (eg, recent surgery, immobilization), patients with a first episode of venous thromboembolism should be referred for age-appropriate cancer screening (eg, colonoscopy) to evaluate for malignancy as a potential risk factor for this disease.
    • Cherry hemangiomas are small, red, cutaneous papules common in aging adults. They do not regressspontaneously, but they are benign and generally do not require treatment.
    • Drug-induced acne is a common side effect of systemic glucocorticoids and is characterized by monomorphic papules without associated comedones, cysts, or nodules. Drug-induced acne does not respond to typical acne treatment but improves rapidly on discontinuation of the offending agent.
    • Patellofemoral pain syndrome (PFPS) is a common cause of anterior knee pain in young women. It is usually due to chronic overuse or malalignment. The pain is provoked by maneuvers (eg, squatting) that involve contraction of the quadriceps with the knee in flexion. Initial management includes activity modification, nonsteroidal anti-inflammatory drugs, and stretching and strengthening exercises
    • Long-term (≥5 years) metformin therapy can cause vitamin B12 deficiency due to alterations in calcium homeostasis, leading to impaired absorption of vitamin B12 in the terminal ileum. Although megaloblastic anemia is often seen, a minority of patients have isolated neurologic findings (eg, paresthesias, sensory ataxia, neuropsychiatric changes).
    • Distal symmetric polyneuropathy
      • Causes: Diabetes mellitus, longstanding HIV, uremia, chemotherapy, medications/toxins
      • Treatment: Gabapentin, SNRIs
    • Infective endocarditis + UTI → Think Enterococcus
    • Melanosis coli → Suggests senna laxative abuse
    • Acute diarrhea
      • Usually causes metabolic acidosis
      • Laxative abuse may instead cause metabolic alkalosis
    • VF or pulseless VT → Immediate defibrillation
    • Greatest risk factor for prostate cancer → Advanced age
    • Postmenopausal osteoporosis
      • First-line treatment: Bisphosphonates
    • Smoking cessation
      • Start with behavioral counseling
      • Most effective medication: Varenicline
      • Consider nicotine replacement therapy (NRT)
      • Bupropion is another option
    • Indications for prophylactic anti-D immune globulin (Rh(D) immune globulin)
      • 28–32 weeks gestation
      • <72 hours after delivery
      • Spontaneous abortion
      • Ectopic pregnancy
      • Threatened abortion
      • Hydatidiform mole
      • Chorionic villus sampling
      • Abdominal trauma
      • Second- or third-trimester bleeding
      • External cephalic version
    • Adjustment disorder
      • First-line: Psychotherapy
    • Brown recluse spider bite
      • Erythema
      • Ulceration
      • Necrosis
    • Vascular rings
      • Biphasic stridor that improves with neck extension
      • Diagnose with CT or MR angiography
    • Transaminitis + elevated ferritin
      • Suggests hereditary hemochromatosis
      • Treatment: Phlebotomy
    • Postoperative unilateral back pain + nausea/vomiting + CVA tenderness
      • Suspect hydronephrosis due to ureteral injury
    • Neurofibromatosis type 1
      • Earliest cutaneous manifestation: Café-au-lait macules
      • Increased risk of optic pathway glioma
      • Symptoms: Morning headache, decreased visual acuity
      • Imaging: MRI of the brain and orbits
    • Wilms tumor
      • Most common renal malignancy in children
      • Unilateral painless abdominal mass
      • May cause hypertension
    • Antidepressants
      • Trial at a therapeutic dose for at least 4–6 weeks
    • Patients on insulin
      • Can develop exercise-induced hypoglycemia
    • Persistent pulmonary hypertension of the newborn (PPHN)
      • Treatment: Oxygen + inhaled nitric oxide
      • Nitric oxide selectively dilates pulmonary vessels, reducing pulmonary vascular resistance
    • High fever + thrombocytopenia + leukopenia + myalgia + arthralgia
      • Suggests dengue fever or chikungunya
    • Progestin IUD
      • Does not increase thromboembolic risk
      • Causes endometrial atrophy
      • Treats heavy menstrual bleeding
    • Patients on dialysis
      • Can develop iron deficiency anemia
    • Trigeminal neuralgia
      • May be unilateral or bilateral
      • Unilateral: Usually vascular nerve compression
      • Bilateral: Suggests secondary causes (e.g., multiple sclerosis); treat the underlying disorder
    • Immediate postoperative fever
      • Usually due to cytokine release from tissue damage
      • Management: Symptomatic treatment
    • Migratory superficial thrombophlebitis (Trousseau syndrome)
      • Associated with occult visceral adenocarcinoma
      • Consider CT abdomen
    • Valproate adverse effects
      • Hepatotoxicity
      • Thrombocytopenia
      • Tremor
    • Suspected scaphoid fracture with negative initial X-ray
      • Obtain CT or MRI, or
      • Splint and repeat X-ray in 7–10 days
    • Hemorrhagic disease of the newborn
      • May cause intracranial hemorrhage
      • Can increase intracranial pressure and lead to hydrocephalus
    • Bloody ascites
      • Most commonly due to hepatocellular carcinoma
    • Upper extremity DVT
      • Risk factors: Central venous catheters (including PICC lines), thoracic outlet obstruction, athletes
      • Treatment: 3 months of anticoagulation
    • Hyperosmolar Hyperglycemic State (HHS)
      • Glucose >600 mg/dL
      • Bicarbonate >18 mEq/L
      • Usually normal anion gap
    • HHS and DKA
      • Serum potassium may be elevated
      • Total body potassium is depleted due to urinary losses
      • Relative hyponatremia due to osmotic water shift
    • Chronic pancreatitis
      • Intermittent abdominal pain worse after eating
      • Pancreatic atrophy
      • Pancreatic calcifications
    • Tourette syndrome
      • Treatment: Habit reversal training
    • Obsessive-compulsive disorder (OCD)
      • Treatment: Exposure and response prevention (ERP)
    • Transfusion-related acute lung injury (TRALI)
      • Respiratory distress
      • Noncardiogenic pulmonary edema
      • Bilateral pulmonary infiltrates
      • Management: Stop transfusion and provide supportive respiratory care
    • Oliguria in infants
      • Expected urine output: At least one void per day of life (first few days)
      • Evaluate with renal and bladder ultrasound
    • Polyhydramnios
      • Asymptomatic: Expectant management
      • Symptomatic: Amnioreduction or indomethacin if <32 weeks gestation
    • Child car seat safety
      • Keep children rear-facing as long as possible
      • Transition to forward-facing only after exceeding the seat's height or weight limits
    • Diabetes insipidus
      • High serum osmolality
      • Polydipsia
      • Urine osmolality <300 mOsm/kg
      • Urine specific gravity <1.006
    • Diabetes mellitus
      • Glucosuria
      • High urine osmolality (>600 mOsm/kg)
    • Bilious emesis in infants
      • Hemodynamically stable infant with bilious emesis and a non-diagnostic X-ray → Upper GI series to evaluate for midgut volvulus
    • Pinealoma (Parinaud syndrome)
      • Limited upward gaze
      • Upper eyelid retraction
      • Pupils with poor reaction to light (light-near dissociation)
    • Obstructive sleep apnea (OSA)
      • Increases the risk of atrial fibrillation
    • Post-thrombotic syndrome
      • Management: Exercise + compression therapy
    • Acute asthma exacerbation
      • Give systemic corticosteroids
      • Reduce late-phase airway inflammation
      • Important to decrease relapse risk after discharge
    • Rhabdomyolysis
      • Dark urine
      • Positive blood on urinalysis without RBCs
      • AKI suggests rhabdomyolysis
    • Hyperkalemia
      • ECG progression:
        1. Tall, peaked T waves
        2. PR prolongation
        3. Loss of P waves
        4. QRS widening
        5. Sine-wave pattern
      • Initial treatment: IV calcium gluconate
    • Suprascapular nerve entrapment
      • Shoulder pain
      • Weakness of abduction (supraspinatus)
      • Weakness of external rotation (infraspinatus)
    • Splenectomy
      • Increased risk of fulminant sepsis due to encapsulated organisms
      • Consider amoxicillin-clavulanate when antibiotic prophylaxis/treatment is indicated
    • Surgical site infection (SSI)
      • Management: Antibiotics + debridement (when indicated)
    • Endometriosis
      • First-line: NSAIDs + combined oral contraceptives (COCs)
      • If symptoms persist → Diagnostic laparoscopy
    • Esophageal perforation (after instrumentation)
      • Commonly occurs after esophageal instrumentation
      • Symptoms: Chest pain, back pain, systemic signs (e.g., fever, sepsis)
      • Chest X-ray: Widened mediastinum
      • Diagnosis: Water-soluble contrast esophagography