Lecture Notes on Review for Step Two Exam

Introduction

• The PowerPoint is a comprehensive study tool for step two of the shelf exam.
• Format: Question-and-answer to facilitate participation and knowledge testing.
• Focus on interactive learning to identify study areas.

Cardiology

• Chest Pain Management:
  • Best first test: EKG
  • Look for ST changes, particularly ST elevation and new left bundle branch block.
• EKG Findings:
  • ST elevation or new left bundle branch block indicates STEMI.
  • T-wave inversion and Q waves appear later.
  • Right coronary artery correlates with leads II, III, and aVF (inferior infarct).
• STEMI Treatment:
  • Restore blood flow: Cath lab preferred.
  • Thrombolytics within 6-hour window.
  • Contraindications: Bleeding, anticoagulated, history of stroke or recent head trauma.
• Right Ventricular Infarction:
  • Symptoms: Hypotension, tachycardia, JVD, and clear lungs.
  • Treatment: Fluids, avoid nitro due to preload issue.

Diagnostic Testing Beyond EKG

• Negative ST elevation leads to cardiac enzyme testing.
  • Myoglobin rises first; useful for repeat infarction.
• Cardiac Cocktail for NSTEMI: Morphine, oxygen, nitrates, aspirin/clopidogrel, beta-blocker.
• Coronary Angiography within 48 hours.

Post-MI Considerations

• Common Post-MI Complications:
  • V-fib is a common cause of death.
  • New systolic murmur: Papillary muscle rupture.
  • Acute hypotension with murmur: Ventricular free wall rupture or septal rupture.
  • Persistent ST elevation and murmur: Ventricular wall aneurysm.
  • Dressler syndrome: Autoimmune pericarditis.

Murmurs

• Systolic Murmurs:
  • Aortic Stenosis: Crescendo-decrescendo, louder with squatting.
  • Hypertrophic Cardiomyopathy: Louder with Valsalva.
  • Mitral Valve Prolapse: Late systolic murmur, click sound.
  • Mitral Regurgitation: Holosystolic murmur, radiates to axilla.
• Diastolic Murmurs: Mitral stenosis and aortic regurgitation.

Cardiac Testing and Treatments

• Stress Tests: Indications and medications to discontinue.
• CHF Management: Reversible causes and treatment improving survival (ACE inhibitors, beta-blockers).

Pulmonary

• Chest X-ray Findings:
  • Pneumonia: Lobar consolidation.
  • COPD: Hyperlucent fields, flat diaphragms.
  • TB: Upper lobe cavitation.
  • Pleural effusions: Transudative vs. exudative characteristics.
• Pulmonary Embolism: Heparin administration and diagnostic tests.
• ARDS: Diagnostic criteria and treatment with PEEP.
• Asthma Classification and Treatments: Based on frequency and severity of symptoms.

Infectious Diseases

• Meningitis: Common bugs and treatments.
• Pneumonia: Common pathogens and treatment strategies.
• HIV: Indicative symptoms, treatment, and prophylaxis.

Nephrology

• Electrolyte Disorders: Hyperkalemia treatment protocol.
• Acid-Base Disorders: Key differentiators and treatments.
• Acute Renal Failure: Diagnosis and management strategies.
• Chronic Kidney Disease: Complications and outpatient management.

Hematology

• Anemias: Microcytic vs. macrocytic, characteristic findings, and treatments.
• Platelet Disorders: ITP and treatment, von Willebrand's disease.
• Coagulation Disorders: DIC, TTP, and treatment approaches.

Conclusion

• Emphasized the importance of understanding clinical scenarios.
• Encouraged questions and additional study using the PowerPoint as a guide.