Couple Questions

[jay426k]

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Hey...Taking my step 2 on the 21st. Anyways just wanted to know if you guys know or have any good algorithms for approaches to lung nodule and thyroid nodules. Honestly I haven't found one good one that I can sit down and memorize for the exam.

Secondly, for causes of meningitis, I haven't found a good source that I can stick to for causes. For instance, in FA step2 it says from 6-60 years old Neisseria is the main cause but before 6 years old Strep. Pneumoniae would be the primary cause. Well on my USMLE world I had a patient that was 4 and they said the primary cause would be Neisseria. Now I understand in medicine there really is no definite answer, however, for the purposes of the USMLE Step 2 exam what is a good cut off for ages?

Thanks again

 

[dmitrinyr]

I don't know about thyroid nodules as I also have trouble remembering those. Here's what USMLE world states regarding meningitis and ages:

Newborn: Group B strep
1 mo-2 years: Strep. Pneumo
2-18 years: Neisseria M.
>18 years: Strep Pneumo.

For adults the most common organism causing meningitis is Strep Pneumoniae eventhough old and immunocompromised pts commonly get meningitis from Listeria.

Hope this helped. Good luck.

 

[mrdowntoearth]

I don't know about thyroid nodules as I also have trouble remembering those. Here's what USMLE world states regarding meningitis and ages:

Newborn: Group B strep
1 mo-2 years: Strep. Pneumo
2-18 years: Neisseria M.
>18 years: Strep Pneumo.

For adults the most common organism causing meningitis is Strep Pneumoniae eventhough old and immunocompromised pts commonly get meningitis from Listeria.

Hope this helped. Good luck.

So are you suggesting to go by UW criteria? There's one question about meningitis in the free 3-block sample questions from NBME and it's a 19 yo college student who has meningitis, but then the answer is N. Meningitidis. I'm so confused.....

 

[NipponMD]

I think it is the college student aspect that would make N. meningitidis more likely since it tends to outbreak in this pt population.

The generaly quoted rates are:
Newborns: group B streptococcus 70%, Listeria 20%, Strep pneumo 10%
1 mo to 2 yrs: Strep pneumo 45%, Neisseria 31%, GBS 18%
2 to 18: Neisseria 60%, Strep pneumo 25%, H Flu 8%
19 - 60: Strep pneumo 60%, Neisseria 20%, H Flu 10%, (GBS & Listeria together 10%)
>60: Strep pneumo 70%, Listeria 20%
This all comes from a review of about 250 pts in 4 states in 1995 - this is where all the stupid memorization comes from!

Hospital aquired tends to be with gram negative bacilli.

The pneumococcal, H Flu, & neisseria vaccines are changing all the rates, so there really is no easy way to deal with the info - and you could argue a bit about what the real answer is.

If you stick to the old guidelines, you'll probably be safe because that is what we all learn.

 

[jay426k]

Alright...Any of you guys know any good approaches to thyroid nodules? For instance they always say FNA is the gold standard but I'm pretty sure you don't take that step everytime someone comes in with a mass felt on their thyroid gland. What should be done first (TSH probably?) and when do you do ultrasound and RAIU?