2015 Step2CK SampleItems

QId: 3993 Pediatrics - Allergy & Immunology
IgA deficiency is associated with autoimmune diseases (celiac disease) and atopy (asthma,
eczema)
in every immunodeficiency
please calculate the B cells, T cells, and check the levels of immunoglobulins.
CVID is associated with autoimmune disorders like RA, thyroid disease
live vaccines are not to be given because of immunodeficiency

the other vaccines cannot elicit an immune response
so there is no use of vaccination
QId: 4686 Medicine - Biostatistics & Epidemiology
to calculate incidence you need to do a cohort study

there is no other way out
QId: 3998 Medicine - Biostatistics & Epidemiology
the two sample t test is a statistical method that is commonly employed to compare the
means of two groups of subjects.
QId: 10763 Medicine - Cardiovascular System

WTF
even cyanide toxicity presents with altered mental status, seizures, lactic acidosis and coma
similar to alcohol withdrawal delirium tremens. but remember alcoholic seizures occur suring
12-48 hours after last intake
so if it is after 5 days - do not think of alcoholic seizures
ADHF:
normal or elevated blood pressure - LMNO
lasix morphine nitroglycerin oxygen (NIV)
hypotension or altered mental status:

LNEO
lasix
norepinephrine
oxygen
QId: 12282 Surgery - Cardiovascular System
local complications of cardiac catheterization:
hematoma: +/- mass, no bruit
pseudoanerysm: bulging pulsatile mass, systolic bruit
AV fistula: no mass, continuous bruit
QId: 4854 Pediatrics - Cardiovascular System
treat viral myocarditis on the ICU due to risk of shock and arrhythmias
treat viral myocarditis by diuretics and inotropes

lol
there are complications of hypertension like left ventricular hypertrophy and hypertensive
retinopathy but no hypertension noted in the clinic
ambulatory blood pressure monitoring is indicated

if the average is >/= 135/85
hypertension can be diagnosed and should be started on treatment
a difference in blood pressure measurements in upper and lower extremity is due to CoA
and generally diff in BP between two upper limbs is considered a clue of aortic dissection
but it can just be due to subclavian stenosis

so do not take difference in BP between two arms as a clue/guide to your diagnosis
QId: 2771 Medicine - Dermatology
photo toxicity is due to the reactive oxygen species that are formed due to the drug
photoallergic reaction is due to UV light changing the structure of the drug molecule
this leads to activation of immune symptoms and eczematous lesions
mupirocin can eradicate MRSA from nares!!!
QId: 3472 Surgery - Dermatology
1. no ulcer
2. ulcer
3. ulcer shows subcutaneous fat
4. ulcer shows bone
non stage-able. ulcer is covered by an eschar which has to be removed for staging
QId: 2778 Pediatrics - Dermatology

why in IDA - the RDW is high
because RBCs are produced throughout the day

and the availability of iron varies with time
hence the variability in size
why in IDA - thrombocytosis

because of the hypoxia the drive for RBC production is high
precursor for both RBC and plat is the same
but iron is not available
so RBC count is LESS but PC is MORE
QId: 3755 Pediatrics - Dermatology
CDM is fine but
if there is cafe au lait spots __ MRI brain

if there is sacral dimple__ Sacral ultrasound
DH can come both before and after the onset of diarrhea
QId: 15962 Surgery - Ear, Nose & Throat (ENT)
candida bhi epiglottitis kar de raha hai

in HIV patients that is
usually it is very severe

so
the treatment is
Anti fungal therapy (Amp -B)
+
vancomycin
+
ceftriaxone
QId: 2190 Medicine - Endocrine, Diabetes & Metabolism

>60 -- BP goal <150/90
<60 -- BP goal <140/90
CKD, DM -- BP goal <140/90
DM with nephropathy -- BP goal try for <130/80
QId: 4124 Obstetrics & Gynecology - Endocrine, Diabetes & Metabolism
so basically
TBG increases
free T decreases
B hCG acts on TSH receptors
Total T increases and Free T comes back to normal
negative feedback
TSH decreases
QId: 12423 Pediatrics - Endocrine, Diabetes & Metabolism
most common complication of infants of diabetic mothers is neonatal hypoglycemia
QId: 4756 Obstetrics & Gynecology - Female Reproductive System & Breast
fecundability is the probability of conception

for which you need a good quality ovum
fecundability decreases starting from the age 35
therefore, even if there are regular periods

there my be infertility
important to note that, in children

vulvar lichen sclerosus is a clinical diagnosis and does not require a vulvar punch biopsy to
rule out malignancy
so
if lichen sclerosus
and abnormal PAP --
it is ca vulva
nowadays culture and microscopy are not used
NAAT is used
if gonococci + chlamydia + azithro + ceftriaxone

if only gonococci + azithro + ceftriaxone (due to emerging ceftriaxone resistance in some
strains)
if only chlamydia + azithro only
chalo
smoker lesbians at least get this one
bacterial vaginosis
what is the protocol of an adnexal mass ?
smoking is proper risk factor
so first
there is an adnexal mass
we do a pelvic ultrasound
we know that there is an ovarian mass
then we do CA 125 (which is not done here)
then we predict the risk of cancer
(in this case there was ovarian mass with ascites, so there is a high chance of malignancy)
if it is high risk for malignancy
exploratory laparotomy and staging
it is very important to differentiate between vulvovaginal atrophy and vulvar lichen sclerosus
so to detect mets
do not do Chest CT do X ray
even if the sensitivity of Ct is higher in detecting mets

thats what we do not want
because it has been seen that

if in a CXR you don't find mets ---> finding them on CT would not change the prognosis
interesting
in the pre-pubertal age

granulosa cell tumors present with precocious puberty
in the elderly age group - peri/post menopausal age group

increased estrogen leads to
breast tissue proliferation leading to fibrocystic changes
endometrial hyperplasia and uterine enlargement
OCPs increase the risk of cervical cancer
OCPs decrease the risk of endometrial and ovarian ca
carboprost is contraindicated in asthma
so then give oxytocin
QId: 3241 Pediatrics - Female Reproductive System & Breast
copper t not only prevents implantation

before that
it is toxic to both the sperm and ova
as a result preventing fertilisation in the first place
vaginal atrophy and vulval lichen sclerosus may present with dryness and pruritis
both osf them may present with dysuria and dysparaeunia
but lichen sclerosus can not involve the vagina

so phrases like - vaginal rugae are absent, intermittent spotting, vaginal petechiae etc will be
s/o vulvovaginal atrophy
bartholin glands cysts are found at the posterior vaginal introitus
skene gland cysts are found in the paraurethral region
gartner duct (remnant of wolfian duct) cyst is found in the upper anterior vagina
generally for post menopausal osteoporosis Bisphophonates are used and is more efficacious
than SERMs
then what are the indications of raloxifene ?
1. intolerance (e.g. pill esophagitis)
2. high risk of invasive breast cancer which can be prevented by giving raloxofene
woa woa woa

for pelvic organ prolapse even in procidentia
surgical and non surgical intervention has similar results
therefore if a patient is a poor surgical risk

use pessaries for her
PID Rx
OPD: i.m. ceftriaoxone + oral doxy
IPD: i.v. cefoxitin or cefotetan + oral doxy

if refractory: i.v. clindamycin + i.v. gentamicin
TOA: add metronidazole
sometimes the only difference between sertoli leydog cell tumor and PCOS is the testosterone
levels
PCOS: there is only hirsutism and no virilisation

SLCT: there is virilisation
suspect syphilis
RPR + TPHA
if negative
empiric i.m. benzathine pn G
repeat RPR @2 weeks to establish baseline titers

repeat RPR @6 months to test for cure
QId: 15710 Surgery - Gastrointestinal & Nutrition
if sliding hernia is symptomatic (reflux symptoms) give PPI

if refractory - nissen fundoplication
if asymptomatic - just observe
only grade IV -- surgical management

grades I II III -- medical management
behavioural and topical analgesics, astringents, hydrocortisone
QId: 2478 Pediatrics - Gastrointestinal & Nutrition
maternal contraindications for breast feeding include

1. active TB within 2 weeks of start of ATT
2. HIV infection (in developed countries)
3. herpetic breast lesions
4. varicella infection <5days prior to or within 2 days of delivery
5. chemo/radio
6. drug abuse/ alcohol
the only infant contraindication of breast feeding

galactosemia

babies acquire a lot a fluid in utero and during labour
this is lost in the form of weight
so there is weight loss upto 7% (not more than that)
during the first 5 days of life
breast feeding frequency : 10-20 minutes each breast q4h
full term infants need vitamin D supplementation
preterm infants need Iron and Vitamin D supplementation
the only solid liver mass that you diagnose by its appearance on imaging and not by history is
focal nodular hyperplasia
presence of a central scar, arterial flow
associated with anomalous arteries
rest of them
hepatic adenoma (OCPs), etc ...
QId: 2977 Medicine - Gastrointestinal & Nutrition
so,
if bilirubin is high
think if it is conjugated or unconjugated (directly by looking at lab values or urinalysis)
if it is conjugated, do LFT
if it is AST ALT >ALP -- do serology etc
if it is ALP > AST ALT -- do abdominal USG and antimitochondrial antibodies
QId: 4647 Medicine - Hematology & Oncology

thrombolytics in DVT only if hemodynamically unstable
!! !! !! !! !! !! !! !! !! !! !!
if stable
use heparin/warfarin/factor Xa inhibitors
QId: 15458 Pediatrics - Hematology & Oncology
this question is amazing

patient's origin is mediterranean
but she bleeds profusely during menses
so the patient is at risk for both thalassemia and IDA
now
which test do you do to diagnose the condition? HB elec or Iron studies
Iron studies . why ?
1. she may be having thal but it may be superadded by IDA
2. you can to some extent differentiate between thal and IDA in Iron studies
3. best is: if there is IDA, due to the already less production of Hb, you will get falsely low
HbA2 result.
your test of Hb elec would be false negative.
so first treat the IDA and then diagnose thal
QId: 4654 Medicine - Infectious Diseases
PCT is associated with HCV was known to me

What I learnt from this question is
In chronic hepatitis C infection the LFTs can be normal ..... shittt
So HAV vaccination is given not because the person is immunocompromised in HIV/AIDS.

It's given only if the person is MSM
Or has chronic liver disease which poses him to have a risk of complications.
Let's say the person got HIV from a needle stick injury
There's no need to give it

Gabalentin is indicated for its herpetic neuralgia and not for acute shingles
So there shouldn't be any issue with choosing one between pain control and infection control
Clearly gabapentin cannot relieve pain acutely
So it's infection control
the lymphadenopathy is typically tender in infectious mononucleosis

this patient had non tender lymphadenopathy
give TMP SMX after solid organ transplantation
QId: 4833 Pediatrics - Infectious Diseases
the treatment of viral meningitis is just supportive

fluids
antipyretics
all babies should receive topical erythromycin ointment

within 1 hour of birth to prevent gonococcal conjunctivitis
which can even lead to blindness
if the baby develops gonococcal conjunctivitis

give i.m. 3rd generation cephalosporin single dose
an interesting finding is
the high platelet count as a marker of inflammation or stress
and unusually even in the presence of inflammation the leukocyte count is normal
so in OM the PC is high and the ESR CRP is high

QId: 4272 Obstetrics & Gynecology - Infectious Diseases
if you have hep c in pregnancy

you should get vaccinated with hep a and hep b
in this case
what is weird is
vancomycin is being used to cover the cephalosporinase resistant pneumococci and not the
MRSA which we usulally use it for.
in children
the most common cause of pneumonia in CF
staph aureus
until 20 years
where pseudomonas has become the major cause
HIV testing
<18months - DNA PCR
>18 months- HIV antibody persistence
Bottom line
In the management of hydatid cyst - the threshold for surgery is very low
And the first line management is albendazole plus percutaneous aspiration (if more than 5 cm
or septations present which is most of the times). Make sure use u avoid spillage
While in the management of amobeic liver abscess - surgery is only considered if there has
been a rupture or pressure symptoms or the diagnosis is not clear . And the first line
management is only albendazole plus paramomycin
Malaria has to have the cyclic fevers symptoms

Otherwise keep malaria low in the differential
Even if the patient has hepataosplenomegaly anemia and raised bilirubin and all those things
Consider other differentials
if either sydenham's chorea or carditis is present after pharyngitis

and fulfilling the required criteria
it is ARF
Doxycycline is used to treat LYMES because it covers borelia lol obviously

But it also cover anaplasma which is transmitted by the same ixodes tick
So that's an extra advantage
If doxy can't be used (children<8, pregnant, lactating mothers) use amoxi

If amoxi allergy- azithromycin
Finally - disseminated disease - i.v. Ceftriaxone
Routine screening is more or less only for HIV

Baki sabka risk/ symptom based hi hai

if the patient is immunised
nothing to be done
if not
is the patient pregnant/immunocompromised/neonate ?
give VZIG
if the patient is immunocompetent

give varicella live vaccine
that will be all
patients with SCD

have functional asplenia
vaccinations against meningococci pneumococci hemophilus
have to be given
even after vaccination the other strains of pneumococci can cause bacteremia and then sepsis
so in addition to vaccination
give penicillin prophylactically upto the age of 5
HIV is the only sexually transmitted disease that is screened for in general population (15-65)
It has 3 types of screenings
initial screening (for general population 15-65) (before starting treatment for another STD or
TB)
annual screening (for high risk patients)
additional screening (pregnancy, exposure)
Other STDs are tested only when there has been an exposure. Syphilis is also screened only
in pregnant
women and when there has been exposure. It is not screened in the general population
because VDRL has many false positives

The risk factors are ketoacidosis, hematologic malignancy, organ and stem cell transplant...
in hematologic malignancy, use of voriconazole is an independent risk factor for development
of mucormycosis
RF is such a bitch
It can be present in IE as well
It's a part of the immunologic manifestations
do not take hepatitis A lightly
give post exposure prophylaxis to contacts
1. household contact/sexual contacts

2. child care center workers where children or coworkers are infected
3. food preparation workers whose coworkers are infected
the nest way to prevent an OI in HIV is by antiretroviral therapy

adjunctive methods are vaccination or antimicrobial prophylaxis
vaccination - pneumococci meningococci

antomicrobial prophylaxis - can be primary or secondary
primary- eg TMPSMX for PCP
secondary - eg acyclovir for HSV recurrence
QId: 15910 Surgery - Male Reproductive System
hydrocele can be reactive to testicular torsion
QId: 2488 Pediatrics - Miscellaneous (Multisystem)
protruding metopic suture = cri du chat syndrome

QId: 3935 Medicine - Nervous System
in migraine, the threshold for prophylactic therapy is thoda high

in cluster headaches prophylactic therapy is the main management
Verapamil, Lithium
even if you do not suspect any ICSOL and the raised ICP is due to pseudotumor cerebri
the next step
is
imaging
CT/MRI
Symmetric ascending paralysis - consider GBS

Acute descending muscle paralysis - consider food borne botulism
GBS can also be caused by

HHV
Mycoplasma
Haemophilus
QId: 2763 Pediatrics - Nervous System
port wine stain can also occur in klippel-trenaunay syndrome

where they have capillary -venous- lymphatic malformations
the difference from sturge weber syndrome is the location of the stain
in SWS it is in the trigeminal nerve V1 V2 distribution

What the hell
Amantadine is a NMDA receptor antagonist and it is not effective in ALZHEIMERS, typically
used in PD
On the other hand memantine - NMDA receptor antagonist is approved for use in moderate
dementia
I mean
What
The
Fuck
Contrast enhanced is not preferred over NCCT not because the contrast is harmful or
anything ...lol
It's just that the contrast will be confused for ACUTE BLOOD which is as hyper dense
in lesch nyhan syndrome

there is accumulation of uric acid and hypoxanthine in urine, blood, and CNS
in CNS it particularly affects the development if dopaminergic pathway

which is responsible for the neuropsychiatric manifestations
rett syndrome is characterized by

speech regression
loss of purposeful hand movements
development of stereotypical movements (pill-rolling, kneading, twisting)
gaitabnormalities
periodic breathing abnormalities (hyperventilation f/b hypoventilation)
this periodic breathing may be due to MECP2 mutation leading to abnormal neuromodulation
in the respiratory center.
Good functional performance status, stable extracranial disease, age less than 65 presents
with any kind of brain mets --) do treat it
Now depending on the following factors choose either surgical resection, stereotactocic radio
surgery, or whole brain radiation therapy
If single lesion and If surgically accessible and good surgical candidate --) surgical resection
followed by SRS and/or WBRT
If single lesion and surgically inaccessible --) SRS
If multiple lesions or poor surgical candidate --) WBRT
If overall poor performance status --) WBRT
Very interesting
The patient presents with sharp short lasting pain in the CHEEKS
Which means the pain is bilateral ..... woah
And the most common cause of bilateral trigeminal neuralgia is MS.
This is supported by the history of sensory loss a few weeks ago which would have been the
first symptom of MS

guidelines are very clear regrading whether or not CT head
may be because the risk of cancers due to CT increases with decreasing age
GCS < 13/ FND, s/o sbasilar skull fractures/seizures..... - admit, CT, close neurological
obsservation every 2 hours
GCS 13-15 - head ache vomiting, brief LOC - no admission - HeadCT to r/o concussion -
send home
or 4-6 hourly neurological examination - if improvement - send home
GCS 15 - completely asymptomatic, non severe mechanism of injury - - send home
Khatarnak baat ye hai ki
In brain death atropine cannot accelerate the heart rate

This is due to the absence of functioning of vagus nerve
Now think why would atropine be ineffective ....?
The interesting part is

There is no vertigo even after severe vestibulopathy
Reason being both sides vestibular organs are equally fucked and so no imbalance between
the inputs from both sides
But instead there is the duniya ghoom rahi hai phenomenon called oscillopsia
Abnormal head thrust test is S/o bilateral vestibulopathy

risk factors of MS are
1. female gender
2. caucasian
3. HLA DRB1
4. cold climate
5. USA, Europe
6. Low vitamin D level
7. smoking
first step in suspected SAH is NCCT head

if it is negative and there is still suspicion of SAH, go for LP to detect RBCs and also
xanthochromia (present for several days after the episode)
After confirming SAH(due to aneurysm), next best step after stabilisation is Cerebral
angiography to detect the aneurysm and coiling, etc
If the abscess is single - due to spread of infection from otitis or sinusitis or mastoiditis
If there are multiple abscesses, it is due to hemtaogenous spread or septic emboli (e.g. IE)
every patient of GBS does not develop respiratory failure
but every patient potentially can

so every patient gets serial spirometry
if the FVC <20mL/kg it indicates impending respiratory failure and therefore proceed with
endotracheal intubation

non pharmacological measures to manage delirium include
1. frequent reorientation
2. trained sitter
3. reducing noise and disturbances
4. avoiding physical constraints
severe sensitivity to antipsychotics

even small doses of risperidone can precipitate parkinsonism
QId: 3383 Psychiatry - Nervous System
benzodiazepines in elderly can cause
cognitive impairment
risk of falls
paradoxical agitation
QId: 14962 Psychiatry - Nervous System
parkinson's only
can have dementia
parkinsonism first then dementia
but less likely to have dementia
+/- visual hallucinations
parkinsons plus dementia (PDD)

will have dementia
parkinsonism first then dementia
+/- visual hallucinations
Dementia with lewy body

will have dementia
will have visual hallucinations
will develop parkinsonism
dementia first then parknsonism
Headache that increases on bending/leaning forward can be just cold
But if headache and other symptoms of increased ICH like blurring of vision worsen on
leaning forward/valsalva/coughing... then that's due to the increased ICH
QId: 15653 Surgery - Nervous System
if there is increased minute ventilation from let us say hyperventilation and even then there is
hypercarbia in ABG
consider malignant hyperthermia (if other symptoms are present too )
the treatment of infant botulism (descending flaccid paralysis from ingestion of C. botulinum
spores from environmental dust) is human derived botulism immune globulin
the treatment of food borne botulism (descending flaccid paralysis from ingestion of
preformed botulinum toxin) is equine derived botulism antitoxin
QId: 2849 Medicine - Ophthalmology
in viral there is a viral prodrome

in this case a nasopharyngeal prodrome
rhinorrhea sore throat
QId: 2850 Medicine - Ophthalmology
the risk of perioperative complications in cataract is low
no need to hold anticoagulants
QId: 4837 Pediatrics - Poisoning & Environmental Exposure

screening for lead poisoning is generally done by capillary sample (just like for blood glucose)
if it is positive
go for venous blood level
to confirm
as well as decide if chelation therapy is required
because chelation therapy is given only if venous lead level is more than 45mcg/dL
QId: 2655 Pediatrics - Poisoning & Environmental Exposure
abdominal pain
hematemesis
metabolic acidosis
hypovolemic shock
iron poisoning
QId: 4511 Medicine - Poisoning & Environmental Exposure
isopropyl alcohol doesn't increase anion gap but increases the serum osmolar gap
heat stroke -- AMS

heat exhaustion -- no AMS
methanol kills the eyes

ethylene glycol kills the kidneys
qrs interval is prolonged if more than 120ms
but in the setting of tca overdose, >100ms qrs is an indication for iv. sodium bicarbonate
QId: 12038 Obstetrics & Gynecology - Pregnancy, Childbirth & Puerperium
If no accelerations -- fetal scalp stimulation to check for fetal acidemia
if variable deceleration -- maternal repositioning, amnio infusion
if any category III FHR tracing -- cesarean section
>/= 1cm cervical dilatation every 2 hours is normal labour progression in the active phase of
labor
no cervical change even after 4 hours of adequate uterine contractions or
no cervical change even after 6 hours of inadequate uterine contractions is termed as labor
arrest disorder
should be managed by cesarean delivery
dont think that now that the uterus is out, let us remove the placenta XD XD
first replace the uterus and then remove the placenta

to avoid the risk of massive hemorrhage
post partum - there is slight amount of red coloured vaginal discharge

that is the decidua - comes out per vaginum in the form of lochia
to isiliye har patient jiska bloody discharge per-vag ho, pelvic USG nahi karna hota
only if PPH + enlarged uterus = pelvic USG indications

differentiation between lupus nephritis and preeclampsia
is difficult
both present with proeteinuria, edema, hypertension
complement levels are low in lupus and associated symptoms like arthralgias, malar rash
the m/c incontinence in pregnancy is SUI
in pregnancy because of positional changes while voiding and uterine enlargement

there can be retrograde vaginal voiding
this can result in a small pool of urine in the posterior vagina that can be appreciated on
speclum examination
placenta produces ALP also now !!!

WTF man
whatever
in Intrahepatic cholestasis
there are no maternal complications
there can be fetal complications but
so we give UDCA and monitor the fetus regularly

if non reassuring at any time --- deliver
if everything's fine but still total bile acids >40micromol/L
deliver
!!
the most important predictor of risk of preterm labor is
cervical length
>20 weeks fetal fibronectin can also be used

if oligohydramnios
you can do vaginal delivery

no need for c section
collapsed skull -- congenital zika syndrome
QId: 3376 Psychiatry - Psychiatric/Behavioral & Substance Abuse
bipolar + schizophrenia with h/o schizophrenia alone

schizoaffective disorder
or it is mood disorder with psychotic features
antisocial personality is just a BAD BAD guy
intermittent explosive disorder is just anger issues
MDD + psychotic feature is in fact an indication of ECT
but should not be used unless there is active suicidality or refusal to eat or drink
if everything is normal otherwise

use SSRI + Anti psychotics

separation anxiety is normal in age group 9-18 months
but is also common to recur during transitions
e.g. starting to go to school
it becomes a disorder when things are excessive

not wanting to go to school , stomach aches , headaches
nightmares
difficulty sleeping alone
etc.
MS - most common psychiatric complication is

depression
people with binge eating disorder

may or may not be overweight
only if they are overweight

they should be started on behavioral weight loss therapy and stimulant - lisdexamfetamine
otherwise
just cognitive behavioral therapy
step 1/FA taught us that conversion disorder is strongly associated with la bella indifferentiae
but it has been shown that this occurs with almost same frequency and hence is not reliable
to differentiate between the two

anterior and medial thalami
corpus callosum
korsakoff syndrome
mamillary body atrophy

dorso medial thalami
wernicke's encephalopathy
corpus callosum and surrounding white matter

marchiafava bignami syndrome
2nd generation antipsychotics have serotonin antagonism apart from dopamine antagonism
which makes them different from the 1st gen antipsychotics
probably why the risk of EPS is far lesser than in 1st gen antipsychotics
antidperessants given in BPD can ppt mania
this risk can be reduced if given along with mood stabilisers
so we think drug form of ECT is clozapine
but here is the exception
catatonia is treated by ECT ( or BZDs) and actually worsened by clozapine or any other
antipsychotic
OCD
SSRI
risk factors for suicide attempt

SAD PERSONS
assessment of risk of suicide and management
suicidal ideation + (wish i was dead/wanna kill myself)

intent + (actually wants to kill himself, going ahead with the idea )
plan + (the method by which he/she will kill themselves)
---> involuntary hospitalisation
ideation + intent + but plan -

break confidentiality and reduce access to potential means
diagnosis is clinical
positive urine drug screen is just supportive
but
selegelline
pseudo ephedrine
bupropion
can give false positive drug screen
people who have a h/o anxiety

are sensitive to early side effects of SSRI (which have been started for depression Rx) which
include agitation, anxiety, insomnia
if the symptoms arise --> decrease the dose of SSRI
to prevent such side effects - start SSRIs at 1/2 dose in such people
QId: 3845 Medicine - Psychiatric/Behavioral & Substance Abuse

if it's a somatic symptom disorder
all that
scheduling regular visits with the same physician is there
but after forming a good rapport with the patient,
he should be eventually referred to psy for treatment
which is ?
SSRI + CBT
pediatric (<18) depression presents with irritability rather than depressed mood
parkinson disease can have psychotic symptoms like visual hallucinations and even more
that does not mean you put it under the category of lewy body dementia
if the patient has bradykinesia + resting tremor or cogwheel rigidity you call him parkison -
simple
if the patient has visual hallucinations and dementia you may call him LBD
also in PD with psychosis - dopamine agonists worsen the symptoms more than
levodopa/carbidopa
if psychotic symptoms are predominant - you can use 2nd generation antipsychotics -
quetiapine, pimavanserin
in childhood if there are symptoms similar to gender dysphoria, the child may probably grow
out of it and no further evaluation is required
in adolescence if it occurs
it requires a multidisciplinary evaluation
because it is likely to be persistent

glue sniffer's rash
peripheral neuropathy from vit b 12 deficiency if nitrous pxide is abused
generally teenagers
usually euphoria, incoherence
sometimes - loss of consciousness - which is very brief
one of the characteristic features of dementia with lewy bodies is its extreme sensitivity to
antipsychotic medication
dementia with Lewy Bodies presents with

visualhallucinations
dementia
parkinsonism
for visual hallucinations we would like to give antipsychotics

if high potency ones like risperidone are given, EPS - rigidity and orthostatic hypotension
would ensue
hence, low potency atypical antipsychotics should be used.
e.g. - Quitiapine
depression is associated
increased s. cortisol levels
decreased hippocampal volume
decreased REM latency
decreased slow wave sleep

when it is only altered mental status
ataxia
slurred speech
it is only BZD
but when vital signs start to derange

suspect more than just BZD
most commonly
BZD + Alcohol
if a patient tells you he/she has thoughts about suicide
and it is given in the question stem about the intent and plan of suicide. choose the option
psychiatrichospitalization
if there is no such mention and no details are given - choose the option - perform suicide risk
assessment
GAD is treated just as depression as is somatic symptom disorder
another similarity between MDD and GAD is the occurrence of somatic symptoms
and hence somatic symptom disorder is also treated the same way
QId: 15092 Pediatrics - Psychiatric/Behavioral & Substance Abuse
language skill regression due to sever epileptic attacks

is seen in
LANDAUKLEFFNERSYNDROME
but this occurs at the age of 6 years as opposed to similar symptoms in Rett syndrome at the
age of 1-2 years and especially in girls

all serotonergic drugs should be stopped 2 weeks prior to starting to a new serotonergic drug
to prevent serotonin syndrome
except for FLUOXETINE

has to stopped 5 weeks prior
due to the longer half life
<200 CD4 count

Long standing HIV
subcortical symptoms - difficulty in executing smooth movements - walking etc
early in the disease course
HIV associated dementia

(a category in HAND)
if sleep terrors become impairing

give low dose benzodiazepines (e.g. clonazepam)
if PCP go for BZD
people with depression can come to you with complains of physical symptoms
psychiatric evaluation of symptoms is necessary
people get depressed due to a medical disorder

(mood disorder due to a medical condition e.g. OSA)
people with acute depression should be check for subs abuse

beware
acute onset depression symptoms
check for subs abuse
lithium
valproate
lamotrigine
quitiapine
are the drugs used for Bipolar disorder

1st line therapy is lithium/valproate + second gen antipsychotic (Quetiapine)
pressured speech uninterruptable - mania

disorganised and rambling speech - psychosis
indications of hospitalization in anorexia nervosa include:
BMI <15kg/m2
marked vital signs
cardiac failure
electrolyte abnormality
acute suicidality
acute food refusal
lack of response to outpatient treatment
indications for antidepressants in anorexia nervosa:
severe comorbid depression

anxiety that persists despite weight restoration
indications for antipsychotics (olanzapine)
severe/refractory anorexia nervosa

single episode unipolar major depression

continuous phase of 6 months after remission and then start the taper
recurrent major depressive disorder/ single episode >= 2 years/ single or multiple episodes
with suicide attempts
maintenance phase X 1-3 years @ continuous phase dose
and then start taper
>=3 episodes of major depressive disorder

maintenance phase @ continuous phase dose X life-long
antidepressant withdrawal presents with anxiety, depressive exacerbations (e.g. insomnia,

loss of appetite)
but half life of SSRI is around 4-6 days
BZD withdrawal presents with anxiety, insomnia, tremor, psychomotor agitation and
dysphoria.
but half life is just 12 hours
so they can have withdrawal even if a day's meds are missed
acute dystonia tardive dyskineia benztropine valbenazine

diphenhydramine
akathasia
propanolol
benztropine
benzodiazepines (not 1st line)
parkinsonism
benztropine
amantadine
venlafaxine can cause dose dependent hypertension
but only sustained levels of high BP warrant discontinuation

so monitoring is required
and people with pre exsiting hypertension

it is better to not start them on this drug but can start with minimal dose and titrate ...
QId: 3020 Medicine - Pulmonary & Critical Care
in ARDS
PaO2/FiO2 ratio <300 mmHg
A-a gradient is high (intrapulmonary shunting)
P-arterial pressure is high
PCWP is normal
QId: 2297 Medicine - Pulmonary & Critical Care
complicaitons of positive pressure ventilation -

alveolar damage
pneumothorax
hypotension
QId: 2821 Medicine - Renal, Urinary Systems & Electrolytes
post ictal lactic acidosis (AG metab ac)

typically resolves within 90 minutes
so repeat ABG after 2 hours
QId: 3942 Medicine - Renal, Urinary Systems & Electrolytes

fibrosis/sclerosis of afferent arteriole, glomerular tuft and then efferent arteriole is
characteristic of hypertensive nephropathy. (2nd most common cause of ESRD)
basement membrane thickening, mesangial expansion and fibrosis is characteristic of diabetic

nephropathy. (most common cause of ESRD)
QId: 3335 Surgery - Renal, Urinary Systems & Electrolytes
if hematuria has no clear cause (infection, calculus, GN)

go for cystoscopy
QId: 15922 Pediatrics - Renal, Urinary Systems & Electrolytes
primary varciocele generally subsides when supine

if it does not
suspect secondary varicocele
in a young child - wilm's tumor for e.g.
QId: 14026 Medicine - Rheumatology/Orthopedics & Sports
plantar fasciitis is not only pain after first steps

also after prolonged standing or walking
QId: 3404 Pediatrics - Rheumatology/Orthopedics & Sports
LCP disease can also result in proximal thigh atrophy and trendelenburg sign may be positive
QId: 4857 Pediatrics - Rheumatology/Orthopedics & Sports
joint pain following 4 weeks after a viral infection
child is otherwise normal
transient synovitis
QId: 12059 Medicine - Rheumatology/Orthopedics & Sports
low back pain (no other diagnosis) : if its <3 weeks moderate activity and NSAIDs are
enough, because the pain is going to go away
but if the pain is >12 weeks - it is more likely to persist and recur
they need proper exercise therapy

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QId: 3993 Pediatrics - Allergy & Immunology

QId: 3195 Pediatrics - Allergy & Immunology

QId: 12519 Pediatrics - Allergy & Immunology

CVID is associated with autoimmune disorders like RA, thyroid disease

QId: 2134 Pediatrics - Allergy & Immunology

live vaccines are not to be given because of immunodeficiency

QId: 4686 Medicine - Biostatistics & Epidemiology

to calculate incidence you need to do a cohort study

QId: 3998 Medicine - Biostatistics & Epidemiology

QId: 10763 Medicine - Cardiovascular System

QId: 6945 Medicine - Cardiovascular System

hypotension or altered mental status:

QId: 12282 Surgery - Cardiovascular System

local complications of cardiac catheterization:

hematoma: +/- mass, no bruit

pseudoanerysm: bulging pulsatile mass, systolic bruit

AV fistula: no mass, continuous bruit

QId: 4854 Pediatrics - Cardiovascular System

QId: 12534 Medicine - Cardiovascular System

ambulatory blood pressure monitoring is indicated

QId: 4682 Medicine - Cardiovascular System

but it can just be due to subclavian stenosis

QId: 2771 Medicine - Dermatology

QId: 4693 Medicine - Dermatology

mupirocin can eradicate MRSA from nares!!!

QId: 3472 Surgery - Dermatology

QId: 2778 Pediatrics - Dermatology

because RBCs are produced throughout the day

why in IDA - thrombocytosis

QId: 3755 Pediatrics - Dermatology

CDM is fine but

if there is cafe au lait spots __ MRI brain

QId: 2774 Medicine - Dermatology

DH can come both before and after the onset of diarrhea

QId: 15962 Surgery - Ear, Nose & Throat (ENT)

candida bhi epiglottitis kar de raha hai

usually it is very severe

QId: 2190 Medicine - Endocrine, Diabetes & Metabolism

QId: 4124 Obstetrics & Gynecology - Endocrine, Diabetes & Metabolism

QId: 12423 Pediatrics - Endocrine, Diabetes & Metabolism

most common complication of infants of diabetic mothers is neonatal hypoglycemia

fecundability is the probability of conception

fecundability decreases starting from the age 35

therefore, even if there are regular periods

important to note that, in children

nowadays culture and microscopy are not used

if gonococci + chlamydia + azithro + ceftriaxone

what is the protocol of an adnexal mass ?

smoking is proper risk factor

even if the sensitivity of Ct is higher in detecting mets

because it has been seen that

in the pre-pubertal age

in the elderly age group - peri/post menopausal age group

OCPs decrease the risk of endometrial and ovarian ca

carboprost is contraindicated in asthma

so then give oxytocin

QId: 3241 Pediatrics - Female Reproductive System & Breast

copper t not only prevents implantation

both osf them may present with dysuria and dysparaeunia

but lichen sclerosus can not involve the vagina

bartholin glands cysts are found at the posterior vaginal introitus

skene gland cysts are found in the paraurethral region