Step 2 / Level 2 Core

Rapid recall drill cards and high-yield summary hubs for rotations and board prep.

Step 2 / Level 2

Clinical Rapid Recall

Cardio

Murmurs, heart failure, ECG patterns, shock.

Murmurs: AS (crescendo-decrescendo, radiates to carotids), MR (holosystolic, apex), AR (diastolic decrescendo), MS (opening snap, diastolic rumble).

Heart failure: S3 (volume overload), S4 (stiff ventricle), JVP elevation, peripheral edema.

Shock: Hypovolemic (low preload), cardiogenic (low output, high filling pressures), distributive (vasodilated, warm early), obstructive (tamponade, PE, tension pneumo).

Pulm

ABGs, COPD/asthma, ILD, PE.

ABG: pH / PaCO2 / HCO3. Acute respiratory acidosis: pH ↓ 0.08 per 10 ↑ PaCO2; chronic: pH ↓ 0.03.

COPD vs asthma: COPD = irreversible, smoking, emphysema/chronic bronchitis; asthma = reversible bronchospasm, eosinophils, triggers.

PE: Wells / PERC, tachypnea, hypoxia, CT-PE, heparin vs thrombolysis if massive.

GI / Renal

Electrolytes, AKI/CKD, liver disease.

AKI: Prerenal (BUN:Cr > 20, FeNa < 1%), intrinsic (ATN, FeNa > 2%), postrenal (obstruction).

Electrolytes: HypoK → U waves; HyperK → peaked T waves, wide QRS; HypoCa → prolonged QT; HyperCa → short QT.

Liver: Child-Pugh, MELD-Na, encephalopathy triggers (infection, GI bleed, dehydration).

Neuro / Psych

Seizures, stroke, dementia, psych meds.

Stroke: Last known well, NIHSS, tPA window, large-vessel occlusion → thrombectomy.

Seizure: ABCs, benzos first line, check glucose, electrolytes, imaging if first seizure.

Dementia: Alzheimer (hippocampal atrophy, low ACh), Lewy body (fluctuating cognition, visual hallucinations), FTD (behavior/personality).

Biostats

Randy Neil Biostats Drills

Sensitivity / Specificity

SnNout, SpPin, PPV/NPV.

SnNout: High Sensitivity → Negative result rules OUT disease.

SpPin: High Specificity → Positive result rules IN disease.

PPV/NPV: Depend on prevalence. Higher prevalence → higher PPV.

Study Designs

RCT, cohort, case-control, cross-sectional.

RCT: Gold standard for treatment; randomization balances confounders.

Cohort: Follows exposed vs unexposed; can calculate relative risk.

Case-control: Starts with outcome; uses odds ratio; prone to recall bias.

Cross-sectional: Snapshot; prevalence only.

Bias & Confounding

Selection, recall, lead-time, Berkson.

Selection bias: Study participants differ systematically from target population.

Recall bias: Cases remember exposures more than controls (retrospective).

Lead-time: Earlier detection appears to prolong survival without improving mortality.

Berkson: Hospital-based controls distort associations.

Statistical Tests

t-test, ANOVA, chi-square, correlation.

t-test: Compare means between 2 groups.

ANOVA: Compare means across ≥3 groups.

Chi-square: Compare categorical proportions.

Pearson r: Linear correlation; r² = percent variance explained.