Social Sciences and Patient Safety
10-15%of exam
Renal, Urinary and Reproductive
7-13%of exam
Cardiovascular System
6-12%of exam
Musculoskeletal, Skin and Subcutaneous
6-12%of exam
Behavioral Health
5-10%of exam
Blood, Lymphoreticular and Immune
5-10%of exam
Gastrointestinal System
5-10%of exam
Nervous System and Special Senses
5-10%of exam
Respiratory System
5-10%of exam
Multisystem Processes and Disorders
4-8%of exam
Endocrine System
3-7%of exam
Pregnancy, Childbirth and Puerperium
3-7%of exam
Biostatistics and Epidemiology
3-5%of exam
Human Development and Well Care
2-4%of exam
Nutrition (Double-Coded Discipline)
15-20%of exam
Quick Facts
- Exam
- USMLE Step 2 CK
- Body
- NBME and FSMB
- Format
- 16 blocks x 30 min
- Items
- 316 (max 318)
- Per block
- Up to 20 items
- Session
- One 9-hour day
- Break
- 55 minutes minimum
- Tutorial
- 5-minute optional
- Pass score
- 218 three-digit scale
- Fee
- $695 (+$235 abroad)
- Attempts
- 4 lifetime, 3 yearly
- Pass rate
- 98% US MD first-takers
- New format
- Effective May 7, 2026
- Provider
- Prometric test centers
Capacity Four Elements
Understand, appreciate, reason, communicate a choice
Capacity is decision-specificCompetence is a legal findingPhysicians assess capacity
RCA vs FMEA
Root cause analysis
- After an event
- Finds the cause
- Retrospective
Failure modes analysis
- Before an event
- Predicts failure modes
- Prospective
Looks back vs forward
Ethics Next Step
- Adult refuses life-saving care→Assess capacity, then honor
- Minor requests contraception→Provide confidentially(State laws vary)
- Unconscious, no surrogate→Treat under implied consent
- Family hides the diagnosis→Ask patient preference first
- Suspected child abuse→Report to authorities(Mandatory)
- Colleague appears impaired→Report to supervisor
- Threat to identified person→Warn and protect
- Language barrier at visit→Use trained interpreter(Not family)
Physician Task Weights
- Diagnosis
- 16-20 percentLargest task
- Lab/diagnostic studies
- 13-17 percent
- Mixed management
- 12-16 percent
- Pharmacotherapy
- 8-12 percent
- Clinical interventions
- 6-10 percent
- Health maintenance
- 5-10 percent
- Prognosis/outcome
- 5-9 percent
- Systems-based practice
- 5-7 percent
- Professionalism
- 5-7 percent
- Practice-based learning
- 3-5 percent
Clinical Science Weights
- Medicine
- 55-65 percentOverlapping
- Pediatrics
- 17-27 percent
- Obstetrics and gynecology
- 10-20 percent
- Psychiatry
- 10-15 percent
- Surgery
- 5-15 percent
- Why totals exceed 100
- Items coded to several sciences
Consent, Capacity, Confidentiality
- Capacity elements
- Understand, appreciate, reason, communicate
- Emancipated minor
- Married, military, or parent
- Minor consent exceptions
- Contraception, pregnancy, infection, substances
- Adult refusing treatment
- Honor when capacity intact
- Surrogate order
- Agent, spouse, adult child
- Advance directive conflict
- Written directive usually controls
- Emergency consent
- Implied when life threatened
- Confidentiality exception
- Serious harm to others
- Mandatory reporting
- Abuse and certain infections
- Impaired colleague
- Report to supervisor first
- Language barrier
- Use trained medical interpreter
Patient Safety and Quality
- Root cause analysis
- Retrospective, after an event
- Failure modes analysis
- Prospective, before an event
- Swiss cheese model
- Aligned system holes
- Never event
- Wrong-site surgery example
- Sentinel event
- Serious unexpected harm
- Error disclosure
- Disclose promptly and honestly
- PDSA cycle
- Plan, do, study, act
- Active error
- Frontline person, immediate effect
- Latent error
- System or design flaw
- Surgical time-out
- Verify patient, site, procedure
- Handoff tool
- SBAR structured communication
Anion Gap Causes
MUDPILES for high anion gap acidosis
M: methanolU: uremiaD: diabetic ketoacidosisP: propylene glycolI: isoniazidL: lactateE: ethylene glycolS: salicylates
Hyponatremia Workup
- Any low sodium→Check serum osmolality
- Normal serum osmolality→Consider pseudohyponatremia
- High serum osmolality→Look for hyperglycemia
- Low osmolality, hypovolemic→Isotonic saline
- Low osmolality, euvolemic→Treat as SIADH(Fluid restriction)
- Seizure or coma→Hypertonic saline now
Electrolytes and Acid-Base
- Sodium correction cap
- 8 mEq/L per 24 hours
- Overcorrection risk
- Osmotic demyelination syndrome
- Severe hyperkalemia
- Calcium gluconate first
- Hyperkalemia ECG
- Peaked T waves
- Anion gap
- Sodium minus chloride minus bicarbonate
- Winter formula
- Expected PaCO2 in acidosis
- Symptomatic hypercalcemia
- Saline, then bisphosphonate
- Prerenal azotemia
- BUN/creatinine over 20
- Acute tubular necrosis
- Muddy brown granular casts
- Contrast nephropathy
- Prevent with isotonic saline
Urology and Gynecology Rules
- Suspected kidney stone
- Noncontrast CT abdomen pelvis
- Stone under 5 mm
- Likely passes, add tamsulosin
- Testicular torsion
- Doppler ultrasound, urgent exploration
- Pyelonephritis
- Culture, then empiric antibiotics
- Abnormal uterine bleeding
- Exclude pregnancy first
- Postmenopausal bleeding
- Endometrial biopsy required
- Polycystic ovary syndrome
- Rotterdam, two of three
- Ectopic pregnancy
- Abnormal hCG rise, empty uterus
- Emergency contraception
- Copper IUD most effective
CHA2DS2-VASc Stroke Risk
Score 2 or more, anticoagulate
C: heart failureH: hypertensionA2: age 75 plusD: diabetesS2: prior strokeV: vascular diseaseA: age 65-74Sc: female sex
Chest Pain Next Step
- ST elevation on ECG→Activate catheterization lab(Under 90 minutes)
- Rising troponin, no elevation→NSTEMI pathway(Antithrombotics)
- Tearing pain to back→CT angiography aorta(Control blood pressure)
- Pleuritic pain with hypoxia→CT pulmonary angiography(Score risk first)
- Absent breath sounds, hypotension→Needle decompression(Do not image)
- Burning, worse lying flat→Trial of PPI(Reflux)
- Reproducible wall tenderness→NSAIDs(Costochondritis)
- Diffuse elevation, PR depression→NSAID plus colchicine(Pericarditis)
BP Stages and Targets
- Normal
- Under 120/802025 guideline
- Elevated
- Systolic 120-129, diastolic normal
- Stage 1
- 130-139 or 80-89
- Stage 2
- 140/90 or higher
- Universal target
- Under 130/80
- Drug trigger
- PREVENT risk 7.5 percent
- First-line agents
- Thiazide, ACE inhibitor, CCB
- Hypertensive emergency
- High BP plus organ damage
- Emergency lowering rate
- About 25 percent, first hour
ACS and Arrhythmia Timing
- STEMI at PCI center
- Balloon within 90 minutes
- STEMI needing transfer
- Balloon within 120 minutes
- No PCI available
- Fibrinolysis within 30 minutes
- First ACS drugs
- Chewed aspirin, nitrates, heparin
- NSTEMI marker
- Rising troponin, no elevation
- Unstable tachycardia
- Synchronized cardioversion now
- Stable narrow SVT
- Vagal, then adenosine
- Pulseless VT or VF
- Defibrillate immediately
- Torsades de pointes
- Intravenous magnesium sulfate
- Atrial fibrillation stroke risk
- CHA2DS2-VASc 2 or more
Heart Failure and Murmurs
- HFrEF pillars
- ARNI, beta-blocker, MRA, SGLT2
- BNP use
- Rules out acute dyspnea
- Acute pulmonary edema
- Oxygen, upright, intravenous furosemide
- Aortic stenosis
- Crescendo-decrescendo, radiates carotids
- Mitral regurgitation
- Holosystolic, radiates axilla
- Hypertrophic cardiomyopathy
- Louder with Valsalva
- Aortic regurgitation
- Decrescendo, wide pulse pressure
- Mitral stenosis
- Opening snap, diastolic rumble
- Cardiac tamponade
- Beck triad, pulsus paradoxus
ABCDE Melanoma Check
Asymmetry, Border, Color, Diameter, Evolving
Diameter over 6 mmEvolving matters mostExcisional biopsy preferred
SJS vs SSSS
Stevens-Johnson
- Mucosal erosions present
- Drug trigger typical
- Full-thickness necrosis
Staph scalded skin
- Mucosa spared
- Staph toxin mediated
- Superficial split
Mucosa involved vs spared
Skin and Joint Emergencies
- Septic arthritis fluid
- White cells over 50,000
- Gout crystals
- Negatively birefringent needles
- Pseudogout crystals
- Positively birefringent rhomboids
- Stevens-Johnson syndrome
- Under 10 percent skin
- Toxic epidermal necrolysis
- Over 30 percent skin
- Necrotizing infection clue
- Pain beyond skin findings
- Simple cellulitis
- Cephalexin unless MRSA suspected
- Melanoma workup
- ABCDE, then excisional biopsy
- Pemphigus vulgaris
- Positive Nikolsky, oral erosions
- Toxic shock syndrome
- Fever, rash, later desquamation
Ortho Decision Rules
- Ottawa ankle rules
- Tenderness or cannot bear weight
- Compartment syndrome
- Pain with passive stretch
- Scaphoid tenderness
- Splint despite normal x-ray
- Open fracture
- Antibiotics and urgent washout
- Elderly hip fracture
- Surgery within 48 hours
- Cauda equina syndrome
- Urgent MRI, then decompression
- Anterior shoulder dislocation
- Check axillary nerve sensation
SIG E CAPS Depression
Five symptoms, two weeks, plus core mood
Sleep, interest, guiltEnergy, concentrationAppetite, psychomotor, suicidalityNeed low mood or anhedonia
Serotonin Syndrome vs NMS
Serotonin syndrome
- Onset within hours
- Hyperreflexia and clonus
- Cyproheptadine
Neuroleptic malignant
- Onset over days
- Lead-pipe rigidity
- Dantrolene or bromocriptine
Clonus vs rigidity
Psychiatry First-Line Choices
- Major depression
- SSRI plus psychotherapy
- Antidepressant trial length
- 4 to 6 weeks
- Bipolar mania
- Lithium or valproate
- Lithium therapeutic level
- 0.6 to 1.2 mEq/L
- Schizophrenia
- Second-generation antipsychotic
- Treatment-resistant schizophrenia
- Clozapine, monitor neutrophils
- Alcohol withdrawal
- Benzodiazepines, symptom-triggered
- Opioid use disorder
- Buprenorphine or methadone
- Panic disorder
- SSRI plus cognitive therapy
- Active suicidal intent
- Ensure safety, hospitalize
TTP vs DIC
TTP
- Normal PT and PTT
- ADAMTS13 deficiency
- Plasma exchange
DIC
- Prolonged PT and PTT
- Low fibrinogen
- Treat underlying cause
Clotting times normal vs prolonged
Transfusion and Coagulation
- Stable transfusion threshold
- Hemoglobin under 7 g/dL
- Prophylactic platelets
- Count under 10,000
- Febrile nonhemolytic reaction
- Fever, chills, no hemolysis
- Acute hemolytic reaction
- ABO mismatch, stop transfusion
- TRALI
- Hypoxia within 6 hours
- Microcytic anemia
- Check iron studies first
- Warfarin reversal
- Four-factor PCC, vitamin K
- Heparin reversal
- Protamine sulfate
- Suspected HIT
- Stop heparin, start argatroban
- Suspected DVT
- Compression ultrasound of leg
Hypersensitivity and Immunodeficiency
- Type I
- IgE, immediate anaphylaxis
- Type II
- Antibody against cell surface
- Type III
- Immune complex deposition
- Type IV
- T cell, delayed onset
- Anaphylaxis first drug
- Intramuscular epinephrine, lateral thigh
- Recurrent sinopulmonary infection
- Check immunoglobulin levels
- Asplenia risk
- Encapsulated organism sepsis
Crohn vs Ulcerative Colitis
Crohn disease
- Mouth to anus
- Skip lesions
- Transmural, fistulas
Ulcerative colitis
- Rectum extending proximally
- Continuous involvement
- Mucosa only
Skip lesions vs continuous
GI and Liver Cutoffs
- Upper GI bleed
- Endoscopy within 24 hours
- Variceal bleed
- Octreotide plus ceftriaxone
- Acute pancreatitis
- Lipase three times normal
- Right upper quadrant pain
- Ultrasound is first test
- Ascending cholangitis
- Charcot triad, urgent ERCP
- Spontaneous bacterial peritonitis
- Ascites neutrophils over 250
- Hepatic encephalopathy
- Lactulose, then rifaximin
- Adult appendicitis
- CT with contrast
- C. difficile colitis
- Oral vancomycin or fidaxomicin
- Celiac testing
- Tissue transglutaminase IgA
Delirium vs Dementia
Delirium
- Acute onset
- Attention impaired
- Often reversible
Dementia
- Months to years
- Memory affected first
- Progressive course
Attention vs memory
Altered Mental Status Picker
- Any altered patient→Check glucose first
- Pinpoint pupils, slow breathing→Give naloxone
- Fever with neck stiffness→Cultures, then antibiotics(Do not delay)
- Sudden focal deficit→Noncontrast head CT(Stroke pathway)
- Alcohol use with confusion→Thiamine before glucose
- Fluctuating attention, acute onset→Treat delirium cause
- Seizure with low sodium→Hypertonic saline bolus
Neurologic Time Windows
- Intravenous thrombolysis
- Within 4.5 hours onset
- Thrombectomy
- Up to 24 hours, selected
- First stroke test
- Noncontrast head CT
- Thunderclap headache
- CT, then lumbar puncture
- Status epilepticus
- Intravenous lorazepam first
- Bacterial meningitis
- Antibiotics before delayed imaging
- Giant cell arteritis
- Steroids before biopsy
- Myasthenic crisis
- Follow vital capacity
- Normal pressure hydrocephalus
- Gait, incontinence, dementia
- Wernicke encephalopathy
- Confusion, ataxia, eye findings
CURB-65 Admission Score
Confusion, Urea, Respirations, BP, age 65
Urea above 19Respirations 30 or moreSystolic under 90Score 2, consider admission
Transudate vs Exudate
Transudate
- Pressure problem
- Heart failure, cirrhosis
- Low protein
Exudate
- Inflammation or infection
- Meets Light criteria
- High LDH
Pressure vs inflammation
Acute Dyspnea Picker
- Wheeze with known asthma→Albuterol and steroids
- Fever with purulent sputum→Treat pneumonia(CURB-65 triage)
- Crackles with high BNP→Intravenous diuresis(Heart failure)
- Pleuritic, tachycardic, hypoxic→Evaluate for embolism
- Stridor and drooling→Secure the airway(Do not examine throat)
- Hypoxia after transfusion→Stop transfusion(Consider TRALI)
- Hyperresonance with hypotension→Needle decompression
Pulmonary Scores and Cutoffs
- CURB-65 of 2
- Consider hospital admission
- Low PE probability
- Apply PERC rule
- D-dimer role
- Rules out low-probability embolism
- PE confirmation
- CT pulmonary angiography
- Asthma exacerbation
- Albuterol, ipratropium, systemic steroids
- COPD exacerbation
- Bronchodilators, steroids, antibiotics
- COPD diagnosis
- Post-bronchodilator FEV1/FVC under 0.70
- Light criteria
- Protein or LDH ratio
- ARDS oxygenation
- PaO2/FiO2 under 300
- Tension pneumothorax
- Decompress before imaging
Sepsis Hour-1 Bundle
Lactate, cultures, antibiotics, fluids, pressors
Cultures before antibiotics30 mL/kg crystalloidNorepinephrine firstRemeasure the lactate
First Imaging Picker
- Right upper quadrant pain→Abdominal ultrasound(Gallstones)
- Suspected appendicitis, adult→CT with contrast
- Suspected appendicitis, child→Ultrasound first(Limit radiation)
- Flank pain with hematuria→Noncontrast CT(Stones)
- Head trauma, red flags→Noncontrast head CT
- Thunderclap headache→Noncontrast head CT(Then lumbar puncture)
- Unstable blunt abdominal trauma→Bedside FAST ultrasound
- Stable suspected dissection→CT angiography
- Acute testicular pain→Doppler ultrasound(Torsion)
- Suspected pulmonary embolism→CT pulmonary angiography
Sepsis and Infection Bundles
- Sepsis definition
- Infection plus organ dysfunction
- Antibiotics in shock
- Within 1 hour
- Initial fluid
- 30 mL/kg crystalloid, 3 hours
- MAP target
- 65 mmHg or higher
- First vasopressor
- Norepinephrine
- Lactate
- Remeasure when above 2
- Adult meningitis empiric
- Vancomycin plus ceftriaxone
- Add ampicillin
- Age over 50, listeria
- Necrotizing fasciitis
- Surgical debridement, not imaging
Toxicology Antidotes
- Acetaminophen
- N-acetylcysteine
- Opioid
- Naloxone
- Benzodiazepine
- Flumazenil, seizure risk
- Organophosphate
- Atropine plus pralidoxime
- Beta-blocker overdose
- Glucagon, then calcium
- Calcium channel blocker
- High-dose insulin, calcium
- Methanol or ethylene glycol
- Fomepizole plus dialysis
- Carbon monoxide
- 100 percent oxygen
- Iron
- Deferoxamine
- Digoxin
- Digoxin-specific antibody fragments
- Salicylate
- Bicarbonate, then dialysis
DKA vs HHS
DKA
- Glucose often over 250
- Anion gap acidosis
- Ketones strongly positive
HHS
- Glucose often over 600
- Osmolality over 320
- Minimal ketones
Acidosis vs osmolality
Diabetes and Thyroid Numbers
- Diabetes A1C
- 6.5 percent or higher
- Fasting glucose
- 126 mg/dL or higher
- Two-hour OGTT
- 200 mg/dL or higher
- Prediabetes A1C
- 5.7 to 6.4 percent
- Usual adult A1C goal
- Under 7 percent
- Type 2 first line
- Metformin plus lifestyle
- Heart or kidney disease
- Add SGLT2 or GLP-1
- DKA hallmark
- Anion gap plus ketones
- Primary hypothyroidism
- High TSH, low T4
- Thyroid nodule workup
- TSH, then ultrasound
Prenatal Timing Anchors
Anatomy 20, glucose 26, strep 36
Anatomy scan 18-22 weeksGlucose challenge 24-28 weeksGroup B strep 36-37 weeksTdap 27-36 weeks
Previa vs Abruption
Placenta previa
- Painless bleeding
- Ultrasound before exam
- No digital exam
Abruption
- Painful bleeding
- Rigid tender uterus
- Largely clinical diagnosis
Painless vs painful
Bleeding in Pregnancy
- First trimester bleeding→Ultrasound and hCG
- Empty uterus, elevated hCG→Treat as ectopic
- Painless third-trimester bleeding→Ultrasound before exam(Previa)
- Painful bleeding, rigid uterus→Prepare for delivery(Abruption)
- Postpartum bleeding, boggy uterus→Massage plus oxytocin
- Rh-negative mother bleeding→Give anti-D globulin
- Membrane rupture with bleeding→Emergency cesarean(Vasa previa)
Prenatal Care Timeline
- Dating ultrasound
- First trimester most accurate
- Cell-free fetal DNA
- From 10 weeks
- Nuchal translucency
- 11-14 weeks
- Quad screen
- 15-22 weeks
- Anatomy ultrasound
- 18-22 weeks
- Glucose challenge
- 24-28 weeks, 50 grams
- Anti-D immune globulin
- 28 weeks and postpartum
- Tdap dose
- 27-36 weeks each pregnancy
- Group B strep culture
- 36w0d to 37w6d
- Antibody screen
- First visit, repeat 28 weeks
Obstetric Emergencies
- Preeclampsia BP
- 140/90 twice, 4 hours apart
- Severe-range BP
- 160/110 or higher
- Severe-feature labs
- Platelets under 100,000
- Eclampsia treatment
- Magnesium sulfate, then delivery
- Aspirin prophylaxis
- 81 mg from 12 weeks
- Magnesium toxicity
- Lost reflexes, give calcium
- Postpartum hemorrhage
- Uterine atony most common
- Shoulder dystocia
- McRoberts, suprapubic pressure
- Chorioamnionitis
- Antibiotics and deliver
Sensitivity vs Specificity
Sensitivity
- Detects disease
- Negative rules out
- Good for screening
Specificity
- Confirms disease
- Positive rules in
- Good for confirmation
Rule out vs rule in
Biostatistics Formulas
- Sensitivity
- True positives among diseased
- Specificity
- True negatives among well
- Positive predictive value
- Rises with prevalence
- Negative predictive value
- Falls as prevalence rises
- Relative risk
- Cohort and trial designs
- Odds ratio
- Case-control designs
- Absolute risk reduction
- Control risk minus treated
- Number needed to treat
- One over absolute reduction
- Incidence
- New cases over time
- Prevalence
- All existing cases now
- Positive likelihood ratio
- Higher value, stronger test
- Type I error
- False positive, alpha
- Type II error
- False negative, beta
- Power
- One minus beta
Study Design and Bias
- Randomized trial
- Strongest causal evidence
- Cohort study
- Exposure first, follow forward
- Case-control study
- Outcome first, look backward
- Cross-sectional study
- Snapshot, yields prevalence
- Lead-time bias
- Earlier diagnosis, unchanged death
- Length-time bias
- Screening favors slow tumors
- Confounding
- Third variable distorts association
- Recall bias
- Case-control interview error
- Berkson bias
- Hospital-based selection problem
- Intention to treat
- Analyze as randomized
Preventive Visit Picker
- Woman turning 40→Offer biennial mammography
- Adult turning 45→Start colorectal screening
- Smoker aged 50 to 80→Annual low-dose CT(20 pack-years)
- Man 65-75 who smoked→One-time aortic ultrasound
- Woman turning 65→Order DXA scan
- Adult 35-70 with obesity→Screen for diabetes
USPSTF Screening Ages
- Mammography
- Biennial, ages 40-742024
- Colorectal screening
- Ages 45 through 752021
- Cervical cytology
- Every 3 years, 21-29
- Cervical age 30-65
- hrHPV every 5 years
- Lung low-dose CT
- Annual, ages 50-8020 pack-years
- Lung quit rule
- Quit within 15 years
- Aortic aneurysm
- Men 65-75 who smokedOne-time
- Osteoporosis DXA
- Women 65 and older2025
- Diabetes screening
- Ages 35-70 with overweight
- HIV screening
- Once, ages 15-65
- Hepatitis C
- Once, ages 18-79
- Statin primary prevention
- 40-75, risk 10 percent
- Depression and anxiety
- Screen all adults
- Prostate PSA
- Shared decision, ages 55-69
Adult Immunization Triggers
- Tdap in pregnancy
- Every pregnancy, 27-36 weeks
- Influenza
- Annual from 6 months
- Recombinant zoster
- Two doses, age 50
- Pneumococcal conjugate
- All adults 50 and older
- HPV series
- Routine 11-12, catch-up 26
- Td booster
- Every 10 years
- RSV vaccine
- Single dose, age 75
- Hepatitis B
- All adults 19-59
Pediatric Milestones
- 2 months
- Social smile
- 6 months
- Sits supported, babbles
- 9 months
- Pulls to stand, stranger anxiety
- 12 months
- First words, walks alone
- 18 months
- Runs, several single words
- 2 years
- Two-word phrases, climbs stairs
- 3 years
- Tricycle, copies circle
- 4 years
- Hops, copies cross
- 5 years
- Skips, copies triangle
Nutrition and Deficiency Clues
- Nutrition weighting
- 15-20 percent, double-codedOverlaps systems
- Refeeding syndrome
- Low phosphate, magnesium, potassium
- Thiamine before glucose
- Prevents Wernicke encephalopathy
- Vitamin B12 deficiency
- Macrocytic with neurologic signs
- Folate deficiency
- Macrocytic, nerves spared
- Vitamin D deficiency
- Low calcium, high PTH
- Vitamin K deficiency
- Prolonged PT and INR
- Zinc deficiency
- Poor healing, perioral rash
- Vitamin A deficiency
- Night blindness, dry eyes
Common Traps
Capacity vs competence
Physicians assess capacity ≠ Courts decide competence
Screening vs diagnosis
Screening finds risk ≠ Diagnosis confirms disease
Sensitivity vs predictive value
Sensitivity ignores prevalence ≠ PPV depends on prevalence
Retrospective vs prospective analysis
RCA looks backward ≠ FMEA looks forward
DKA vs HHS
DKA has acidosis ≠ HHS has extreme osmolality
Previa vs abruption
Previa bleeding is painless ≠ Abruption bleeding is painful
Lead-time vs length-time bias
Lead-time shifts diagnosis earlier ≠ Length-time favors slow tumors
Delirium vs dementia
Delirium impairs attention ≠ Dementia impairs memory
Folate vs B12 deficiency
Both cause macrocytosis ≠ Only B12 harms nerves
Gout vs pseudogout crystals
Gout has negative birefringence ≠ Pseudogout has positive birefringence
Nutrition weighting confusion
Nutrition is double-coded ≠ Systems already total 100
Block count vs item count
Sixteen 30-minute blocks now ≠ Item total is unchanged
Last Minute
- 1.Sixteen 30-minute blocks, 9-hour day
- 2.Up to 20 items per block
- 3.55 minutes break, 5-minute tutorial
- 4.Passing score is 218
- 5.Fee $695; $235 outside US/Canada
- 6.Three attempts yearly, four lifetime
- 7.Report 30 minutes before start
- 8.Bring unexpired photo-signature ID
- 9.Social sciences is largest system
- 10.Diagnosis tasks are 16-20 percent
- 11.Mammography 40-74; colon from 45
- 12.Lung CT 50-80, 20 pack-years
- 13.Blood pressure target under 130/80
- 14.Stroke thrombolysis within 4.5 hours
- 15.Septic shock antibiotics within 1 hour
- 16.Raise sodium under 8 daily
- 17.Transfuse when hemoglobin under 7
- 18.Check glucose in every confusion
- 19.Group B strep culture 36-37 weeks
- 20.Capacity is decision-specific, not global
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