M. Maheer Mubashir

Prothrombin time is the best determinant of risk at 48-72 hours after ingestion in cases of paracetemol overdose. (reflects the functional and synthetic capacity of liver, best predicts the risk because of short half life of factor VII, which is involved in extrinsic pathway)

Pericarditis and myopericarditis are usually viral or idiopathic. First-line therapy is NSAIDs + colchicine. Glucocorticoids are reserved for refractory cases, NSAID contraindications (eg. CKD), or specific causes due to higher recurrence risk.

Pheochromocytoma can remain silent until triggered (eg, anesthesia, surgical manipulation). Screen with plasma/urine metanephrines. If elevated, confirm with CT/MRI for adrenal mass.

@hashimfaisal799 🫡

@maheerium Pura step2 prha dein twitter pe maheer bhai 😋

Pneumococcal meningitis is associated is high mortality+morbidity, especially sensorineural hearing loss. Use steroids to reduce the risk of SNHL. Contacts do not require prophylaxis, compared to meningococcal meningitis, in which rifampin is given to contacts as prophylaxis.

Abdominal swelling, mild ankle edema, hypertension and mild proteinuria in a young female should raise suspicion for nephrotic syndrome. But get a urinary beta-hCG to rule out pregnancy first. Hypertension and proteinuria suggest pre-eclampsia.

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A key sign that distinguishes Pulmonary embolism from a Panic attack on the boards is Cyanosis. PE results in V/Q mismatch that can cause ↓O2 and cyanosis. Hyperventilation due to panic attack causes ↑O2 and hypocapnia which can result in distal paresthesia, dizziness and LOC.

@ex_moonshot A Step 2CK tip is a practical pearl to help you diagnose/manage clinical scenario/question on exam day. A Step 2CK fact is guideline or evidence-based information you’re expected to know. Hope it answers the question.

@maheerium Dr. Mubashir, can you please elaborate the difference between a step 2Ck fact and a step 2Ck tip?

STEP 2CK Fact: In patients on dual antiplatelet therapy, prior Gastrointestinal Bleeding, peptic ulcer disease, active H. pylori, and age >65 raise the risk of upper GIB. Proton pump inhibitors lower this risk in high-risk patients.

STEP 2CK Tip: Tachycardia-induced cardiomyopathy may occur in patients with persistent tachyarrhythmias and sustained rapid ventricular rates. Treatment: Restore sinus rhythm or tightly control ventricular rate, which often results in partial or complete recovery of LV function.

a right bundle branch block–like pattern. Placement of an implantable cardioverter-defibrillator (ICD) is recommended for patients who present with syncope.

Brugada syndrome is a condition that may lead to syncope and sudden cardiac death in individuals with structurally normal hearts. Characteristic ECG findings include more than 2 mm of coved ST-segment elevation in the right precordial leads, accompanied by T-wave inversion and

Hemolysis can cause intracellular potassium to be released extracellularly, giving a false positive. Redrawing of arterial blood with care to prevent hemolysis is the next best step.

If you see a patient with severe hyperkalemia (>8mEq/L) with a normal EKG on the exam, it should raise the possibility of pseudohyperkalemia. Almost all patients with a serum K > 8 mEq/L have EKG changes. The next best step is to get a blood redraw and repeat electrolytes.

11 years. feeling old already. #MyTwitterAnniversary

@hussnain_m_10 Congratulations Husnsain bhai!

After a long and tiring journey, finally done with this beast of Usmle Step 2 CK. Wonderful start to 2025, yet the grind doesn't stop! Closing this chapter with gratitude to my mentors. you can reach if you have any questions.

@HuzaifaKhann5 you deserve all the great things in life Huzaifa bhai! Congratulations ♥️