https://thecodexes.com/image-bank/plates/AUDIO-B08-027/ https://thecodexes.com/image-bank/plates/AXR-DOUBLE-BUBBLE/ https://thecodexes.com/assets/MED-0efbde68f065aa472e87/original.jpg Duodenal atresia Duodenal atresia (AXR-DOUBLE-BUBBLE) — Double-bubble with no distal gas: duodenal atresia — bilious vomiting on day 1, Down syndrome association. — Free USMLE® Step 2 CK ImageBank plate with source… https://thecodexes.com/image-bank/plates/AXR-FREE-AIR/ https://thecodexes.com/assets/MED-59b4b6b5c96a35d9928c/original.jpg Pneumoperitoneum Pneumoperitoneum (AXR-FREE-AIR) — Free intraperitoneal air suggests a perforated hollow viscus; with peritonitis or sepsis, begin resuscitation and antibiotics and obtain urgent surgical source… https://thecodexes.com/image-bank/plates/AXR-NEC/ https://thecodexes.com/assets/MED-637d11a443b6f20ca71a/original.jpg Necrotizing enterocolitis Necrotizing enterocolitis (AXR-NEC) — Necrotizing enterocolitis: pneumatosis intestinalis (intramural gas) in a preterm infant — NPO, antibiotics; free air means surgery. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/AXR-SBO/ https://thecodexes.com/assets/MED-cd72591208eb15cdf7ef/original.jpg Small bowel obstruction Small bowel obstruction (AXR-SBO) — Small-bowel obstruction: dilated loops with stacked air-fluid levels and a paucity of colonic gas — NG decompression; surgery for strangulation. — Free USMLE®… https://thecodexes.com/image-bank/plates/AXR-SIGMOID-VOLV/ https://thecodexes.com/assets/MED-1c740dab9764dfb55652/original.jpg Sigmoid volvulus Sigmoid volvulus (AXR-SIGMOID-VOLV) — Sigmoid volvulus: coffee-bean loop pointing to the right upper quadrant — sigmoidoscopic detorsion, then elective sigmoidectomy. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/AXR-TOXIC-MEGA/ https://thecodexes.com/assets/MED-cd30f6b400493c697204/original.jpg Toxic megacolon Toxic megacolon (AXR-TOXIC-MEGA) — Toxic megacolon is nonobstructive colonic dilation with systemic toxicity. Avoid full colonoscopy and antimotility drugs; obtain urgent surgical assessment and… https://thecodexes.com/image-bank/plates/CLIN-KOPLIK-SPOTS/ https://thecodexes.com/assets/MED-370826d0a4e0657860ad/original.webp Koplik spots Koplik spots (CLIN-KOPLIK-SPOTS) — A second CDC view shows palatal and oropharyngeal Koplik spots. — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on… https://thecodexes.com/image-bank/plates/CLIN-PETECHIAE/ https://thecodexes.com/assets/MED-4409fdad1a7bb543c28b/original.webp Petechiae Petechiae (CLIN-PETECHIAE) — Perifollicular petechiae; the source does not establish their cause. — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on TheCodexes.com. https://thecodexes.com/image-bank/plates/CT-AAA/ https://thecodexes.com/assets/MED-a35d093a20f0298e6bec/original.jpg Abdominal aortic aneurysm Abdominal aortic aneurysm (CT-AAA) — AAA repair is recommended at ≥5.5 cm in men, ≥5.0 cm in women, or for attributable symptoms; rapid growth also prompts repair assessment. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/CT-AORTIC-DISSECTION/ https://thecodexes.com/assets/MED-ef917ac4467e004b14c9/original.jpg Aortic dissection on CTA Aortic dissection on CTA (CT-AORTIC-DISSECTION) — CTA can show an intimal flap dividing the true and false lumens. Stanford type A involves the ascending aorta and changes the urgent management… https://thecodexes.com/image-bank/plates/CT-APPENDICITIS/ https://thecodexes.com/assets/MED-0903d70de273ee1535de/original.jpg Acute appendicitis Acute appendicitis (CT-APPENDICITIS) — Appendicitis on CT: dilated appendix >6 mm with wall enhancement and fat stranding — ultrasound first in children and pregnancy. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/CT-B01-024/ https://thecodexes.com/assets/MED-668f43fa42ee6b8d8cc0/original.png Symmetric hypodensity within the bilateral parieto-occipital white matter without… Symmetric hypodensity within the bilateral parieto-occipital white matter without… (CT-B01-024) — Severe hypertension + headache, confusion, visual loss + symmetric posterior white matter edema →… https://thecodexes.com/image-bank/plates/CT-B02-016/ https://thecodexes.com/assets/MED-134ad0b5717ef1359a6f/original.jpg Saddle embolus straddling the main pulmonary artery bifurcation with RV:LV diameter… Saddle embolus straddling the main pulmonary artery bifurcation with RV:LV diameter… (CT-B02-016) — Platelets fall >50% on heparin days 5–10 + new clot → HIT: stop all heparin, start argatroban; no… https://thecodexes.com/image-bank/plates/CT-B03-001b/ https://thecodexes.com/assets/MED-c69f16d4fb7fb477ea30/original.jpg CT chest with oral contrast showing extraluminal contrast extravasation from the left… CT chest with oral contrast showing extraluminal contrast extravasation from the left… (CT-B03-001b) — Esophageal perforation with an uncontained leak or sepsis → antibiotics and emergency surgical… https://thecodexes.com/image-bank/plates/CT-B03-013/ https://thecodexes.com/assets/MED-365a3201bcc5edfb0356/original.jpg 6-cm hepatic mass with arterial hyperenhancement and portal venous washout (LI-RADS… 6-cm hepatic mass with arterial hyperenhancement and portal venous washout (LI-RADS… (CT-B03-013) — Advanced HCC with preserved liver function may receive atezolizumab–bevacizumab or another… https://thecodexes.com/image-bank/plates/CT-B04-019/ https://thecodexes.com/assets/MED-d0904f5f872bf06c0a50/original.jpg Non-contrast CT showing a hyperdense calculus impacted in the proximal ureter with… Non-contrast CT showing a hyperdense calculus impacted in the proximal ureter with… (CT-B04-019) — Obstructing stone with infection or sepsis requires urgent stent or nephrostomy drainage plus… https://thecodexes.com/image-bank/plates/CT-B06-029/ https://thecodexes.com/assets/MED-ab2520964f827faf874b/original.gif Contrast-enhanced axial CT of the abdomen showing a large heterogeneous right renal… Contrast-enhanced axial CT of the abdomen showing a large heterogeneous right renal… (CT-B06-029) — Child with intrarenal flank mass and claw sign → chest CT staging, then nephrectomy; no… https://thecodexes.com/image-bank/plates/CT-B07-036/ https://thecodexes.com/assets/MED-c6298c61a1bc92272e39/original.jpg Noncontrast head CT of a neonate showing bilateral periventricular hyperdense… Noncontrast head CT of a neonate showing bilateral periventricular hyperdense… (CT-B07-036) — Periventricular calcifications + microcephaly + hearing loss → congenital CMV → urine or saliva PCR… https://thecodexes.com/image-bank/plates/CT-DIVERTICULITIS/ https://thecodexes.com/assets/MED-a448d31c3611b8bda888/original.jpg Sigmoid diverticulitis Sigmoid diverticulitis (CT-DIVERTICULITIS) — Sigmoid diverticulitis on CT: wall thickening with pericolic fat stranding — abscess >3 cm gets percutaneous drainage; colonoscopy after 6–8 weeks.… https://thecodexes.com/image-bank/plates/CT-E2-055/ https://thecodexes.com/assets/MED-53655b2e8e416a4f150b/original.jpg Wall thickening/mass at the gastroesophageal junction on contrast-enhanced CT… Wall thickening/mass at the gastroesophageal junction on contrast-enhanced CT… (CT-E2-055) — Biopsy-proven esophageal or junctional cancer with negative CT and PET-CT → endoscopic ultrasound for T… https://thecodexes.com/image-bank/plates/CT-E2-143/ https://thecodexes.com/assets/MED-5313c9a7f54b3c79e49e/original.png Contrast-enhanced abdominal CT with coarse pancreatic parenchymal calcifications,… Contrast-enhanced abdominal CT with coarse pancreatic parenchymal calcifications,… (CT-E2-143) — Chronic pancreatitis + isolated gastric varices + splenomegaly with normal liver → splenic vein… https://thecodexes.com/image-bank/plates/CT-E3-004/ https://thecodexes.com/assets/MED-0d34fb9b47c0d337b402/original.jpg Segmental colonic wall thickening with adjacent mesenteric fat stranding involving the… Segmental colonic wall thickening with adjacent mesenteric fat stranding involving the… (CT-E3-004) — Sudden crampy pain + modest bloody stool + recent low-flow state → ischemic colitis at a… https://thecodexes.com/image-bank/plates/CT-EPIDURAL/ https://thecodexes.com/assets/MED-a5d22a11505639b81571/original.jpg Epidural hematoma CT Epidural hematoma CT (CT-EPIDURAL) — Epidural hematoma is typically biconvex and limited by sutures. Obtain urgent neurosurgical evaluation; large or symptomatic lesions require evacuation, while… https://thecodexes.com/image-bank/plates/CT-HYDRO/ https://thecodexes.com/assets/MED-8ebed8b0f8a7111042c3/original.jpg Hydrocephalus CT Hydrocephalus CT (CT-HYDRO) — Hydrocephalus: ventriculomegaly out of proportion to sulcal atrophy — communicating vs obstructive decides shunt vs ETV. — Free USMLE® Step 2 CK ImageBank plate with… https://thecodexes.com/image-bank/plates/CT-ICH/ https://thecodexes.com/assets/MED-52d6c56f43b09629863b/original.jpg Intracerebral hemorrhage CT Intracerebral hemorrhage CT (CT-ICH) — Acute intracerebral hemorrhage requires prompt anticoagulant reversal when indicated and specialist care. In mild to moderate spontaneous ICH with presenting… https://thecodexes.com/image-bank/plates/CT-MCA-STROKE/ https://thecodexes.com/assets/MED-5ddb84a64b33a6ae4aad/original.jpg MCA stroke CT MCA stroke CT (CT-MCA-STROKE) — MCA infarct: hyperdense MCA sign early, then wedge-shaped hypodensity — CT is to exclude bleeding before tPA, not to see the infarct. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/CT-PANCREATITIS/ https://thecodexes.com/assets/MED-98199b9d34df06a1a0bd/original.jpg Acute pancreatitis CT Acute pancreatitis CT (CT-PANCREATITIS) — Diagnose acute pancreatitis clinically and biochemically. Use contrast CT when the diagnosis is uncertain or complications are suspected; a nonenhancing… https://thecodexes.com/image-bank/plates/CT-PE/ https://thecodexes.com/assets/MED-5b851fa4e1421f14d12d/original.png Pulmonary embolism Pulmonary embolism (CT-PE) — CT pulmonary angiography can demonstrate pulmonary arterial filling defects. Anticoagulate when appropriate and assess clinical severity; PE with shock requires urgent… https://thecodexes.com/image-bank/plates/CT-RENAL-STONE/ https://thecodexes.com/assets/MED-5a054b1d74a9254ac8df/original.jpg Ureteral stone CT Ureteral stone CT (CT-RENAL-STONE) — Small uncomplicated ureteral stones often pass with analgesia and observation; alpha-blockers chiefly benefit distal stones 5–10 mm. Infected obstruction or… https://thecodexes.com/image-bank/plates/CT-SAH/ https://thecodexes.com/assets/MED-31e6873f277fc572b68b/original.jpg Subarachnoid hemorrhage CT Subarachnoid hemorrhage CT (CT-SAH) — Suspected SAH requires urgent noncontrast CT. If presentation is beyond six hours or there is a new neurologic deficit and CT is negative, perform lumbar… https://thecodexes.com/image-bank/plates/CT-SUBDURAL/ https://thecodexes.com/assets/MED-a03c800c5d03f076e5a8/original.jpg Subdural hematoma CT Subdural hematoma CT (CT-SUBDURAL) — Subdural hematoma: crescent-shaped collection that crosses sutures — bridging veins; elderly, anticoagulated, alcohol-use patients. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/CXR-AORTA-WIDE/ https://thecodexes.com/assets/MED-3edfb250f83a810960a5/original.jpg Aortic dissection Aortic dissection (CXR-AORTA-WIDE) — Widened mediastinum with tearing chest pain: dissection until proven otherwise — CT angiography, and control heart rate before pressure. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/CXR-ARDS/ https://thecodexes.com/assets/MED-d79752585504569bf146/original.jpg Acute respiratory distress syndrome Acute respiratory distress syndrome (CXR-ARDS) — ARDS involves acute hypoxemia with bilateral opacities not fully explained by cardiac failure or fluid overload. Use lung-protective ventilation with… https://thecodexes.com/image-bank/plates/CXR-B10-038/ https://thecodexes.com/assets/MED-96098fd9f3adee365221/original.jpg Neonatal chest radiograph with an orogastric tube coiled in a blind upper esophageal… Neonatal chest radiograph with an orogastric tube coiled in a blind upper esophageal… (CXR-B10-038) — A coiled tube in the upper pouch with abdominal gas suggests esophageal atresia with distal… https://thecodexes.com/image-bank/plates/CXR-CHF/ https://thecodexes.com/assets/MED-58c28d45e3db54187730/original.png Cardiogenic pulmonary edema Cardiogenic pulmonary edema (CXR-CHF) — Cardiogenic pulmonary edema: cardiomegaly, vascular cephalization, Kerley B lines and perihilar 'bat-wing' opacities. — Free USMLE® Step 2 CK ImageBank plate… https://thecodexes.com/image-bank/plates/CXR-COPD/ https://thecodexes.com/assets/MED-84d0443890ada5b547e2/original.jpg Emphysema Emphysema (CXR-COPD) — Emphysema: hyperinflation with flattened hemidiaphragms and a narrow vertical heart — diagnosis rests on spirometry (FEV1/FVC <0.7), not the film. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/CXR-EFFUSION/ https://thecodexes.com/assets/MED-15e11a2c4584b55ed6e4/original.jpg Pleural effusion Pleural effusion (CXR-EFFUSION) — Pleural effusion: blunted costophrenic angle with a meniscus — decubitus film or ultrasound before thoracentesis; Light's criteria classify it. — Free USMLE® Step 2… https://thecodexes.com/image-bank/plates/CXR-HEMOTHORAX-TRAUMA/ https://thecodexes.com/assets/MED-73af1a1bb6a1ef4b28fd/original.jpg Traumatic hemothorax Traumatic hemothorax (CXR-HEMOTHORAX-TRAUMA) — Traumatic hemothorax: chest tube; >1,500 mL at insertion or >200 mL/h for 2–4 h means thoracotomy. — Free USMLE® Step 2 CK ImageBank plate with source… https://thecodexes.com/image-bank/plates/CXR-LOBAR-PNA/ https://thecodexes.com/assets/MED-d9bda8b818b6a60f09f5/original.jpg Lobar pneumonia Lobar pneumonia (CXR-LOBAR-PNA) — Lobar consolidation with air bronchograms supports an air-space process; with an infectious presentation, treat pneumonia according to severity and risk factors.… https://thecodexes.com/image-bank/plates/CXR-MILIARY/ https://thecodexes.com/assets/MED-7b4c870ecc6bc34f02c8/original.jpg Miliary tuberculosis Miliary tuberculosis (CXR-MILIARY) — Miliary tuberculosis: diffuse millet-seed nodules — disseminated disease; start four-drug therapy without waiting for cultures. — Free USMLE® Step 2 CK ImageBank… https://thecodexes.com/image-bank/plates/CXR-NEONATE-RDS/ https://thecodexes.com/assets/MED-724be77599fbc1cdfd8d/original.webp Neonatal respiratory distress Neonatal respiratory distress (CXR-NEONATE-RDS) — Neonatal respiratory distress syndrome: ground-glass lungs with air bronchograms in a preterm infant — surfactant and CPAP. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/CXR-PEDS-EPIGLOTTITIS/ https://thecodexes.com/assets/MED-d0694e79603132bc2ae7/original.jpg Epiglottitis and croup Epiglottitis and croup (CXR-PEDS-EPIGLOTTITIS) — Thumbprint sign on lateral neck film = epiglottitis (secure airway in the OR); steeple sign on AP = croup (dexamethasone ± racemic epinephrine).… https://thecodexes.com/image-bank/plates/CXR-PTX/ https://thecodexes.com/assets/MED-a1cf308751177271b799/original.png Pneumothorax Pneumothorax (CXR-PTX) — Pneumothorax produces a visceral pleural line with absent peripheral lung markings. Suspected tension physiology with hemodynamic instability or severe respiratory… https://thecodexes.com/image-bank/plates/CXR-SARCOID/ https://thecodexes.com/assets/MED-f830a059fc57d00acd5d/original.png Sarcoidosis hilar adenopathy Sarcoidosis hilar adenopathy (CXR-SARCOID) — Bilateral hilar lymphadenopathy in a young adult: sarcoidosis — biopsy shows noncaseating granulomas; exclude TB and lymphoma. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/CXR-TB-CAV/ https://thecodexes.com/assets/MED-9f06700e17df194e8bd2/original.jpg Cavitary tuberculosis Cavitary tuberculosis (CXR-TB-CAV) — Reactivation tuberculosis: apical/upper-lobe cavitation — airborne isolation, three sputum AFB smears and NAAT. — Free USMLE® Step 2 CK ImageBank plate with… https://thecodexes.com/image-bank/plates/DIAG-ACID-BASE-FOUR-DECISIONS/ https://thecodexes.com/assets/MED-e9bc31a2265c50ccfb9c/original.svg ABG and anion-gap interpretation in four decisions ABG and anion-gap interpretation in four decisions (DIAG-ACID-BASE-FOUR-DECISIONS) — Original educational diagram; interactive labels reveal concise exam facts. — Free USMLE® Step 1 ImageBank plate… https://thecodexes.com/image-bank/plates/DIAG-CROSSED-BRAINSTEM/ https://thecodexes.com/assets/MED-0d9023a75dd71915b3a9/original.svg Crossed brainstem signs: medulla, pons, and midbrain Crossed brainstem signs: medulla, pons, and midbrain (DIAG-CROSSED-BRAINSTEM) — Original educational diagram; interactive labels reveal concise exam facts. — Free USMLE® Step 1 ImageBank plate with… https://thecodexes.com/image-bank/plates/DIAG-FETAL-NEWBORN-SHUNTS/ https://thecodexes.com/assets/MED-20cc6ae877ca129d319b/original.svg Fetal-to-newborn circulation and shunt direction Fetal-to-newborn circulation and shunt direction (DIAG-FETAL-NEWBORN-SHUNTS) — Original educational diagram; interactive labels reveal concise exam facts. — Free USMLE® Step 1 ImageBank plate with… https://thecodexes.com/image-bank/plates/DIAG-FOREST-PLOT/ https://thecodexes.com/assets/MED-b22dccba894c62c1d7f3/original.svg Forest plot of pooled risk ratios Forest plot of pooled risk ratios (DIAG-FOREST-PLOT) — Individual confidence intervals cross 1.0, while the pooled diamond lies entirely below 1.0 in this hypothetical example. — Free USMLE® Step 1… https://thecodexes.com/image-bank/plates/DIAG-HYPOXEMIA-VQ/ https://thecodexes.com/assets/MED-761eaee948a5ba0d1222/original.svg From A-a gradient to V/Q, dead space, and true shunt From A-a gradient to V/Q, dead space, and true shunt (DIAG-HYPOXEMIA-VQ) — Original educational diagram; interactive labels reveal concise exam facts. — Free USMLE® Step 1 ImageBank plate with… https://thecodexes.com/image-bank/plates/DIAG-KAPLAN-MEIER/ https://thecodexes.com/assets/MED-8980b95e9f4000417d75/original.svg Time-to-event curves with censoring Time-to-event curves with censoring (DIAG-KAPLAN-MEIER) — Compare the two step-function curves over time and identify the censored observations; Arm A remains above Arm B. — Free USMLE® Step 1… https://thecodexes.com/image-bank/plates/DIAG-MURMUR-MANEUVERS/ https://thecodexes.com/assets/MED-f904318593960b423584/original.svg Murmurs that change with preload and afterload Murmurs that change with preload and afterload (DIAG-MURMUR-MANEUVERS) — Original educational diagram; interactive labels reveal concise exam facts. — Free USMLE® Step 1 ImageBank plate with source… https://thecodexes.com/image-bank/plates/DIAG-PARADOXICAL-S2/ https://thecodexes.com/assets/MED-3d9db34f6b0e1ede33e9/original.svg Second heart sound during respiration Second heart sound during respiration (DIAG-PARADOXICAL-S2) — On expiration, identify P2 followed by A2; on inspiration, the interval narrows. This is a stylized phonocardiogram, not patient audio.… https://thecodexes.com/image-bank/plates/DIAG-RNS-DECREMENT/ https://thecodexes.com/assets/MED-a03583a358557a679186/original.svg Repetitive nerve stimulation decrement Repetitive nerve stimulation decrement (DIAG-RNS-DECREMENT) — The fourth CMAP is 12% smaller than the first in this illustrative five-stimulus series. — Free USMLE® Step 1 ImageBank plate with… https://thecodexes.com/image-bank/plates/DIAG-ROC-AUC/ https://thecodexes.com/assets/MED-916c62e08e2bb20dbc6e/original.svg ROC curve with AUC 0.91 ROC curve with AUC 0.91 (DIAG-ROC-AUC) — The curve bows toward the upper-left corner and lies above the diagonal no-discrimination line; AUC is 0.91. — Free USMLE® Step 1 ImageBank plate with source… https://thecodexes.com/image-bank/plates/DIAG-RTA-NEPHRON-MAP/ https://thecodexes.com/assets/MED-fe9afb07d1be41aaad10/original.svg RTA types mapped to the nephron RTA types mapped to the nephron (DIAG-RTA-NEPHRON-MAP) — Original educational diagram; interactive labels reveal concise exam facts. — Free USMLE® Step 1 ImageBank plate with source evidence and… https://thecodexes.com/image-bank/plates/DIAG-S3-GALLOP/ https://thecodexes.com/assets/MED-aac1db8667d534fee52d/original.svg Early-diastolic extra heart sound Early-diastolic extra heart sound (DIAG-S3-GALLOP) — The extra low-amplitude sound follows S2 in early diastole. This is a stylized phonocardiogram, not patient audio. — Free USMLE® Step 1 ImageBank… https://thecodexes.com/image-bank/plates/DIAG-S4-GALLOP/ https://thecodexes.com/assets/MED-fa0b6311492f7a61aa91/original.svg Presystolic extra heart sound Presystolic extra heart sound (DIAG-S4-GALLOP) — The extra low-amplitude sound occurs immediately before S1, late in diastole. This is a stylized phonocardiogram, not patient audio. — Free USMLE®… https://thecodexes.com/image-bank/plates/DIAG-SHOCK-HEMODYNAMICS/ https://thecodexes.com/assets/MED-c4cf49739ca6096f7f2d/original.svg Shock profiles at the bedside and catheter Shock profiles at the bedside and catheter (DIAG-SHOCK-HEMODYNAMICS) — Original educational diagram; interactive labels reveal concise exam facts. — Free USMLE® Step 1 ImageBank plate with source… https://thecodexes.com/image-bank/plates/DIAG-V24-ACID-BASE/ https://thecodexes.com/assets/MED-c8426702f0f9455a396f/original.svg Acid–base: four decisions Acid–base: four decisions (DIAG-V24-ACID-BASE) — A reproducible interpretation sequence — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on TheCodexes.com. https://thecodexes.com/image-bank/plates/DIAG-V24-ADH-ANP/ https://thecodexes.com/assets/MED-5457ebf8311ff3310b04/original.svg ADH receptors & ANP ADH receptors & ANP (DIAG-V24-ADH-ANP) — Compare water retention, vasoconstriction and natriuresis — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on… https://thecodexes.com/image-bank/plates/DIAG-V24-ATTRIBUTABLE-RISK/ https://thecodexes.com/assets/MED-5b45c3ef44b40fce0bb8/original.svg Attributable risk: count vs share Attributable risk: count vs share (DIAG-V24-ATTRIBUTABLE-RISK) — See what exposure adds among exposed people — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on… https://thecodexes.com/image-bank/plates/DIAG-V24-CD-MARKERS/ https://thecodexes.com/assets/MED-96959bf37b839b8b8bc1/original.svg CD markers that change the answer CD markers that change the answer (DIAG-V24-CD-MARKERS) — A compact cell-ID and mechanism matrix — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on TheCodexes.com. https://thecodexes.com/image-bank/plates/DIAG-V24-DNA-REPAIR/ https://thecodexes.com/assets/MED-039e5c03839da9df4ea8/original.svg DNA replication & repair DNA replication & repair (DIAG-V24-DNA-REPAIR) — Match the lesion to the repair route — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on TheCodexes.com. https://thecodexes.com/image-bank/plates/DIAG-V24-EARLY-EMBRYOLOGY/ https://thecodexes.com/assets/MED-b569f4e0ef967c2692e6/original.svg Early embryo & germ layers Early embryo & germ layers (DIAG-V24-EARLY-EMBRYOLOGY) — Time the event; then locate its tissue of origin — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on… https://thecodexes.com/image-bank/plates/DIAG-V24-ELECTROLYTES/ https://thecodexes.com/assets/MED-83446e9acd9ed4d811b6/original.svg K⁺, Mg²⁺ & Na⁺ decisions K⁺, Mg²⁺ & Na⁺ decisions (DIAG-V24-ELECTROLYTES) — Separate shifts, losses and water balance — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on TheCodexes.com. https://thecodexes.com/image-bank/plates/DIAG-V24-ENDOMETRIAL-TYPES/ https://thecodexes.com/assets/MED-4b082c963db5931c4ce3/original.svg Endometrial cancer patterns Endometrial cancer patterns (DIAG-V24-ENDOMETRIAL-TYPES) — A contrast map for endometrioid and serous tumors — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on… https://thecodexes.com/image-bank/plates/DIAG-V24-GUT-TUBE/ https://thecodexes.com/assets/MED-02f328c4df64f92e221e/original.svg Gut tube, arteries & rotation Gut tube, arteries & rotation (DIAG-V24-GUT-TUBE) — One map for foregut, midgut and hindgut — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on TheCodexes.com. https://thecodexes.com/image-bank/plates/DIAG-V24-INCRETIN-DRUGS/ https://thecodexes.com/assets/MED-23f5a3633e7148ff2d78/original.svg Incretin drug mechanisms Incretin drug mechanisms (DIAG-V24-INCRETIN-DRUGS) — Separate DPP-4, GLP-1 and SGLT2 targets — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on TheCodexes.com. https://thecodexes.com/image-bank/plates/DIAG-V24-NEURO-LOCALIZATION/ https://thecodexes.com/assets/MED-d84887acb268eb8310fb/original.svg Cerebellum · basal ganglia · thalamus Cerebellum · basal ganglia · thalamus (DIAG-V24-NEURO-LOCALIZATION) — Locate the circuit from the exam finding — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on… https://thecodexes.com/image-bank/plates/DIAG-V24-ONCOLOGY-DRUGS/ https://thecodexes.com/assets/MED-41ab1331492b24f3c794/original.svg Cancer drug mechanism map Cancer drug mechanism map (DIAG-V24-ONCOLOGY-DRUGS) — Connect the target with its signature toxicity — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on… https://thecodexes.com/image-bank/plates/DIAG-V24-PHAGOCYTE-DEFECTS/ https://thecodexes.com/assets/MED-e1add322191ecb49f6e1/original.svg Phagocyte defect sorter Phagocyte defect sorter (DIAG-V24-PHAGOCYTE-DEFECTS) — Localize the failure: travel, granules or killing — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on… https://thecodexes.com/image-bank/plates/DIAG-V24-PHARYNGEAL-APPARATUS/ https://thecodexes.com/assets/MED-2c239b271dee86e4887c/original.svg Pharyngeal apparatus atlas Pharyngeal apparatus atlas (DIAG-V24-PHARYNGEAL-APPARATUS) — Keep arch, pouch and cleft derivatives apart — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on… https://thecodexes.com/image-bank/plates/DIAG-V24-RENAL-CLEARANCE/ https://thecodexes.com/assets/MED-14d069ab7ca2e4bb498a/original.svg Renal clearance & FENa Renal clearance & FENa (DIAG-V24-RENAL-CLEARANCE) — Choose the equation that answers the vignette — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on TheCodexes.com. https://thecodexes.com/image-bank/plates/DIAG-V24-RENAL-EMBRYOLOGY/ https://thecodexes.com/assets/MED-1867f3887c31ec26055d/original.svg Kidney development & anomalies Kidney development & anomalies (DIAG-V24-RENAL-EMBRYOLOGY) — Two interacting tissues build one kidney — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on… https://thecodexes.com/image-bank/plates/DIAG-V24-RENAL-GLUCOSE/ https://thecodexes.com/assets/MED-21139067491480a9b49d/original.svg Renal glucose: threshold ≠ Tm Renal glucose: threshold ≠ Tm (DIAG-V24-RENAL-GLUCOSE) — See why glucose appears before all carriers saturate — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on… https://thecodexes.com/image-bank/plates/DIAG-V24-RNA-TRANSLATION/ https://thecodexes.com/assets/MED-87aa1c2610598181a19a/original.svg From DNA to protein From DNA to protein (DIAG-V24-RNA-TRANSLATION) — A three-stage map of expression and drug targets — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on TheCodexes.com. https://thecodexes.com/image-bank/plates/DIAG-V24-T-CELL-IMMUNODEFICIENCY/ https://thecodexes.com/assets/MED-30ee8cab1d64e7660d63/original.svg Combined & T-cell deficiencies Combined & T-cell deficiencies (DIAG-V24-T-CELL-IMMUNODEFICIENCY) — Pattern-match the immune compartment — Free USMLE® Step 1 ImageBank plate with source evidence and MyCodexes study links on… https://thecodexes.com/image-bank/plates/DIAG-VISUAL-FIELD-LOCALIZER/ https://thecodexes.com/assets/MED-54c8361c2c2825f50c19/original.svg Visual pathway lesions and field defects Visual pathway lesions and field defects (DIAG-VISUAL-FIELD-LOCALIZER) — Original educational diagram; interactive labels reveal concise exam facts. — Free USMLE® Step 1 ImageBank plate with source… https://thecodexes.com/image-bank/plates/DIF-DERMATITIS-HERPETIFORMIS-IGA/ https://thecodexes.com/assets/MED-0fd4c66cf5a239c29725/original.png Dermatitis herpetiformis — direct immunofluorescence Dermatitis herpetiformis — direct immunofluorescence (DIF-DERMATITIS-HERPETIFORMIS-IGA) — In the lower-right panel, granular green IgA fluorescence follows the papillary dermal–epidermal junction.… https://thecodexes.com/image-bank/plates/ECG-AFIB/ https://thecodexes.com/assets/MED-43c86dc7b8b7a743e650/original.png Atrial fibrillation Atrial fibrillation (ECG-AFIB) — Atrial fibrillation: irregularly irregular RR intervals with no discernible P waves. — Free USMLE® Step 2 CK ImageBank plate with source evidence and MyCodexes study… https://thecodexes.com/image-bank/plates/ECG-AFLUTTER/ https://thecodexes.com/assets/MED-b0b1118ef8616b9edb3f/original.jpg Atrial flutter Atrial flutter (ECG-AFLUTTER) — Atrial flutter 2:1: sawtooth flutter waves in the inferior leads at a ventricular rate near 150/min. — Free USMLE® Step 2 CK ImageBank plate with source evidence and… https://thecodexes.com/image-bank/plates/ECG-AVB-2-MOBITZ2/ https://thecodexes.com/assets/MED-69d609c2c4b4dd4d7d5b/original.jpg Mobitz II block Mobitz II block (ECG-AVB-2-MOBITZ2) — Mobitz type II: fixed PR with unpredictable dropped beats — infranodal; pacemaker. — Free USMLE® Step 2 CK ImageBank plate with source evidence and MyCodexes… https://thecodexes.com/image-bank/plates/ECG-AVB-2-WENCK/ https://thecodexes.com/assets/MED-391099a306ba753f6a8d/original.jpg Mobitz I block Mobitz I block (ECG-AVB-2-WENCK) — Mobitz I shows progressive PR prolongation before a nonconducted P wave; asymptomatic AV-nodal block often needs observation, while symptomatic or unstable… https://thecodexes.com/image-bank/plates/ECG-AVB-3/ https://thecodexes.com/assets/MED-ae80b7ed29b5ee3c21e8/original.jpg Complete heart block Complete heart block (ECG-AVB-3) — Third-degree AV block: atrial and ventricular rhythms march independently — pacemaker. — Free USMLE® Step 2 CK ImageBank plate with source evidence and MyCodexes… https://thecodexes.com/image-bank/plates/ECG-B01-007/ https://thecodexes.com/assets/MED-a7932acc3316aed851d2/original.jpg Irregularly irregular wide-complex tachycardia at a rate of approximately 190-220/min,… Irregularly irregular wide-complex tachycardia at a rate of approximately 190-220/min,… (ECG-B01-007) — Irregular wide-complex tachycardia with varying QRS → pre-excited AF: procainamide or… https://thecodexes.com/image-bank/plates/ECG-B01-009/ https://thecodexes.com/assets/MED-997f33c8ee62203d2095/original.jpg 12-lead ECG with tall, narrow-based, symmetric peaked T waves in V2–V5, flattened P… 12-lead ECG with tall, narrow-based, symmetric peaked T waves in V2–V5, flattened P… (ECG-B01-009) — Hypotension with hyponatremia, hypoglycemia, and possible hyperkalemia suggests adrenal crisis… https://thecodexes.com/image-bank/plates/ECG-B01-015/ https://thecodexes.com/assets/MED-4fa6a44cae557c5df8aa/original.jpg Regular wide-complex tachycardia (QRS >120 ms) at a rate of 170/min with AV… Regular wide-complex tachycardia (QRS >120 ms) at a rate of 170/min with AV… (ECG-B01-015) — Treat wide-complex tachycardia of uncertain origin as VT. Avoid verapamil and diltiazem; instability… https://thecodexes.com/image-bank/plates/ECG-B01-018/ https://thecodexes.com/assets/MED-4fcebc464e74da220811/original.jpg Inferior STEMI (ST elevation II, III, aVF, reciprocal aVL) with Mobitz type I… Inferior STEMI (ST elevation II, III, aVF, reciprocal aVL) with Mobitz type I… (ECG-B01-018) — Inferior MI can cause transient AV nodal block. Treat bradycardia when it causes hemodynamic compromise… https://thecodexes.com/image-bank/plates/ECG-B01-019/ https://thecodexes.com/assets/MED-6e18459291eafa4e99eb/original.jpg Sinus tachycardia at a rate of 110/min without ST-segment or T-wave abnormalities. Sinus tachycardia at a rate of 110/min without ST-segment or T-wave abnormalities. (ECG-B01-019) — Hypotension after a nitrate in a PDE5-inhibitor user → supine position and IV fluids. Exception… https://thecodexes.com/image-bank/plates/ECG-B01-021/ https://thecodexes.com/assets/MED-a4c211ff3dde26a1b02f/original.jpg 12-lead ECG with peaked narrow-based T waves in V2–V4, flattened P waves, and QRS… 12-lead ECG with peaked narrow-based T waves in V2–V4, flattened P waves, and QRS… (ECG-B01-021) — New hyperkalemia on stable ACE inhibitor or MRA → look for trimethoprim, NSAIDs, or heparin; give… https://thecodexes.com/image-bank/plates/ECG-B01-025/ https://thecodexes.com/assets/MED-591aec75eb5ae89e1745/original.jpg Regular wide-complex tachycardia at about 168/min, QRS about 180 ms, LBBB-like… Regular wide-complex tachycardia at about 168/min, QRS about 180 ms, LBBB-like… (ECG-B01-025) — Wide-complex tachycardia + prior MI or low EF → ventricular tachycardia regardless of stability… https://thecodexes.com/image-bank/plates/ECG-B01-031/ https://thecodexes.com/assets/MED-7ad3a2232d37730fe2f2/original.jpg Convex ST-segment elevation in V1–V5, maximal (5 mm) in V2, with reciprocal ST… Convex ST-segment elevation in V1–V5, maximal (5 mm) in V2, with reciprocal ST… (ECG-B01-031) — After fibrinolysis → check the lead of maximal ST elevation at 60–90 minutes; <50% resolution → rescue… https://thecodexes.com/image-bank/plates/ECG-B01-032/ https://thecodexes.com/assets/MED-90478ac671af25ee89d6/original.jpg Sinus rhythm, QRS 162 ms, LBBB morphology with broad notched R waves in I/aVL/V5-V6,… Sinus rhythm, QRS 162 ms, LBBB morphology with broad notched R waves in I/aVL/V5-V6,… (ECG-B01-032) — CRT is strongly indicated in appropriate patients with LVEF ≤35%, sinus rhythm, LBBB, QRS ≥150… https://thecodexes.com/image-bank/plates/ECG-B01-034/ https://thecodexes.com/assets/MED-461ecb52a259ac11f277/original.png Atrial fibrillation with rapid ventricular response: irregularly irregular narrow QRS… Atrial fibrillation with rapid ventricular response: irregularly irregular narrow QRS… (ECG-B01-034) — Sudden cortical deficits + infarcts in more than one arterial territory + atrial fibrillation →… https://thecodexes.com/image-bank/plates/ECG-B01-035/ https://thecodexes.com/assets/MED-34d888134e92885351ef/original.jpg Deep, symmetric T-wave inversions in V2–V4 without ST elevation or Q waves (Wellens… Deep, symmetric T-wave inversions in V2–V4 without ST elevation or Q waves (Wellens… (ECG-B01-035) — NSTEMI with rising troponin or new ischemic T-wave changes (including Wellens) → angiography… https://thecodexes.com/image-bank/plates/ECG-B01-039/ https://thecodexes.com/assets/MED-caa10774e0baed900ef0/original.png Chaotic, disorganized baseline with variable-amplitude undulations and no identifiable… Chaotic, disorganized baseline with variable-amplitude undulations and no identifiable… (ECG-B01-039) — Pulseless VF or VT → immediate unsynchronized shock, then 2 minutes of CPR. Exception… https://thecodexes.com/image-bank/plates/ECG-B10-037/ https://thecodexes.com/assets/MED-03a08e12b62f6556fd90/original.png Infant ECG at 118/min with QT 380 ms (QTc about 530 ms) and notched low-amplitude T… Infant ECG at 118/min with QT 380 ms (QTc about 530 ms) and notched low-amplitude T… (ECG-B10-037) — An infant event triggered by startle plus family syncope or young sudden death warrants QTc… https://thecodexes.com/image-bank/plates/ECG-BRUGADA/ https://thecodexes.com/assets/MED-840f2e3cd421b1d2072e/original.jpg Brugada pattern Brugada pattern (ECG-BRUGADA) — Type 1: coved ST elevation ≥2 mm in V1 or V2 with T-wave inversion. ICD is indicated after survived cardiac arrest or documented spontaneous sustained VT; consider it… https://thecodexes.com/image-bank/plates/ECG-DIGOXIN/ https://thecodexes.com/assets/MED-fe29d2903f70252d2772/original.png Digoxin effect Digoxin effect (ECG-DIGOXIN) — Digoxin effect: sagging 'reverse-tick' ST depression — effect, not toxicity; toxicity is arrhythmia plus GI/visual symptoms. — Free USMLE® Step 2 CK ImageBank plate… https://thecodexes.com/image-bank/plates/ECG-E1-018/ https://thecodexes.com/assets/MED-8b1504ac68a39e17a391/original.png 12-lead ECG with horizontal ST depression in V1–V3, tall broad R waves with R/S ratio… 12-lead ECG with horizontal ST depression in V1–V3, tall broad R waves with R/S ratio… (ECG-E1-018) — Ischemic chest pain with ST depression maximal in V1–V3 and tall R waves warrants posterior… https://thecodexes.com/image-bank/plates/ECG-E1-106/ https://thecodexes.com/assets/MED-e16e3895069be0b374d2/original.png Rapid irregularly irregular rhythm (atrial fibrillation) abruptly terminating into a… Rapid irregularly irregular rhythm (atrial fibrillation) abruptly terminating into a… (ECG-E1-106) — Tachycardia-bradycardia syndrome with symptomatic pauses → pacemaker before rate-control drugs… https://thecodexes.com/image-bank/plates/ECG-E1-160/ https://thecodexes.com/assets/MED-2411c8c01f1d23988d58/original.jpg Regular narrow-complex tachycardia at ~180/min with no discernible P waves and a… Regular narrow-complex tachycardia at ~180/min with no discernible P waves and a… (ECG-E1-160) — Regular narrow-complex tachycardia with terminal pseudo-R' in V1 that vanishes in sinus rhythm →… https://thecodexes.com/image-bank/plates/ECG-E1-276/ https://thecodexes.com/assets/MED-83b2ef13d366c8ca9f2e/original.jpg ST-segment elevation in leads II, III, and aVF with reciprocal ST depression in leads… ST-segment elevation in leads II, III, and aVF with reciprocal ST depression in leads… (ECG-E1-276) — Resuscitated from ventricular fibrillation + territorial ST elevation with reciprocal depression… https://thecodexes.com/image-bank/plates/ECG-E1-315/ https://thecodexes.com/assets/MED-add0175d15793730e7b5/original.png Rhythm strip of torsades de pointes: polymorphic QRS complexes twisting in amplitude… Rhythm strip of torsades de pointes: polymorphic QRS complexes twisting in amplitude… (ECG-E1-315) — Long-QT polymorphic VT suggests torsades de pointes. Sustained polymorphic VT requires immediate… https://thecodexes.com/image-bank/plates/ECG-E1-344/ https://thecodexes.com/assets/MED-88a67a0207c4a20668d0/original.jpg Sinus bradycardia with prolonged PR, QRS, and QT intervals, prominent Osborn (J) waves… Sinus bradycardia with prolonged PR, QRS, and QT intervals, prominent Osborn (J) waves… (ECG-E1-344) — Bradycardia + prolonged PR, QRS, and QT + inferolateral J waves → hypothermia; measure core… https://thecodexes.com/image-bank/plates/ECG-E1-349/ https://thecodexes.com/assets/MED-f420ef61d45fe00a037c/original.jpg Flattened or inverted T waves in multiple leads with prominent U waves immediately… Flattened or inverted T waves in multiple leads with prominent U waves immediately… (ECG-E1-349) — Loop diuretic with hypokalemia and U waves → check and replace magnesium, or potassium repletion… https://thecodexes.com/image-bank/plates/ECG-E1-361/ https://thecodexes.com/assets/MED-565835169521810235cd/original.jpg Sinus tachycardia with an S1Q3T3 pattern (S wave in lead I, Q wave and T-wave… Sinus tachycardia with an S1Q3T3 pattern (S wave in lead I, Q wave and T-wave… (ECG-E1-361) — Suspected PE with shock requires urgent assessment and reperfusion planning. Bedside echocardiography… https://thecodexes.com/image-bank/plates/ECG-E2-087/ https://thecodexes.com/assets/MED-c754aa1bd16627f9c7cd/original.png Epsilon wave (small deflection immediately following the QRS) and T-wave inversions in… Epsilon wave (small deflection immediately following the QRS) and T-wave inversions in… (ECG-E2-087) — Exertional syncope, right precordial T-wave inversion with post-QRS deflection, and right… https://thecodexes.com/image-bank/plates/ECG-E2-094/ https://thecodexes.com/assets/MED-ab194c2a73d285ae51c6/original.png Early beat with abnormal P-wave morphology (distinct from sinus P waves) preceding a… Early beat with abnormal P-wave morphology (distinct from sinus P waves) preceding a… (ECG-E2-094) — Early beat with abnormal P wave, narrow QRS, and noncompensatory pause → premature atrial… https://thecodexes.com/image-bank/plates/ECG-E2-120/ https://thecodexes.com/assets/MED-fab7052cf9d1be5f7f2c/original.jpg Sinus tachycardia with low-voltage QRS complexes in limb and precordial leads and… Sinus tachycardia with low-voltage QRS complexes in limb and precordial leads and… (ECG-E2-120) — Low voltage + alternans + JVD + hypotension → tamponade: small fluid bolus while pericardiocentesis… https://thecodexes.com/image-bank/plates/ECG-E2-132/ https://thecodexes.com/assets/MED-220dbb48b623e4c8a6fd/original.jpg Diffuse concave-upward (saddle-shaped) ST-segment elevation in multiple non-contiguous… Diffuse concave-upward (saddle-shaped) ST-segment elevation in multiple non-contiguous… (ECG-E2-132) — Pericarditis and arthralgias during exposure to hydralazine, procainamide, or isoniazid suggest… https://thecodexes.com/image-bank/plates/ECG-E2-194/ https://thecodexes.com/assets/MED-701b43324385bbd5145b/original.png Polymorphic VT with twisting QRS axis around the isoelectric baseline (torsades de… Polymorphic VT with twisting QRS axis around the isoelectric baseline (torsades de… (ECG-E2-194) — Torsades with QTc >500 ms on QT-prolonging drugs plus low potassium and magnesium → acquired long… https://thecodexes.com/image-bank/plates/ECG-E2-300/ https://thecodexes.com/assets/MED-107a0d7294c70bacdc04/original.png Coved-type (type 1) ST-segment elevation ≥2 mm in leads V1-V2 with a convex,… Coved-type (type 1) ST-segment elevation ≥2 mm in leads V1-V2 with a convex,… (ECG-E2-300) — Fever-provoked coved ST elevation in V1-V2 + syncope or family sudden death → Brugada syndrome: treat… https://thecodexes.com/image-bank/plates/ECG-E2-346/ https://thecodexes.com/assets/MED-9067ff13bad7515c5b4e/original.jpg Diffuse concave (saddle-shaped) ST elevation in I, II, aVF, V2–V6 with PR depression… Diffuse concave (saddle-shaped) ST elevation in I, II, aVF, V2–V6 with PR depression… (ECG-E2-346) — Pericarditis weeks after MI → high-dose aspirin plus colchicine. Exception: no recent MI → any… https://thecodexes.com/image-bank/plates/ECG-E2-365/ https://thecodexes.com/assets/MED-9784b1b1108da1835313/original.jpg Diffuse concave ST elevation across multiple territories with PR depression in the… Diffuse concave ST elevation across multiple territories with PR depression in the… (ECG-E2-365) — Diffuse ST elevation with PR depression supports acute pericarditis; uncomplicated cases are… https://thecodexes.com/image-bank/plates/ECG-HYPERK/ https://thecodexes.com/assets/MED-11e2ddaa7d70054c94d6/original.png Hyperkalemia ECG Hyperkalemia ECG (ECG-HYPERK) — Hyperkalemia: peaked T waves progressing to a widened QRS and sine wave — calcium gluconate first. — Free USMLE® Step 2 CK ImageBank plate with source evidence and… https://thecodexes.com/image-bank/plates/ECG-LBBB/ https://thecodexes.com/assets/MED-d24be1bd73c72faf55c8/original.jpg Left bundle branch block Left bundle branch block (ECG-LBBB) — LBBB shows QRS ≥120 ms with broad lateral R waves. New LBBB alone is not a STEMI equivalent; assess ischemic symptoms and Sgarbossa or modified Sgarbossa… https://thecodexes.com/image-bank/plates/ECG-LONGQT/ https://thecodexes.com/assets/MED-e615b38f1ebe1ea6920e/original.png Long QT syndrome Long QT syndrome (ECG-LONGQT) — Prolonged QT predisposes to torsades; QTc above 500 ms is a high-risk marker, not a required diagnostic threshold for long-QT syndrome. Review drugs, electrolytes… https://thecodexes.com/image-bank/plates/ECG-PERICARDITIS/ https://thecodexes.com/assets/MED-f434fd11d89dd09555f4/original.png Acute pericarditis Acute pericarditis (ECG-PERICARDITIS) — Acute pericarditis: diffuse concave ST elevation with PR depression, and PR elevation in aVR — not a territorial STEMI. — Free USMLE® Step 2 CK ImageBank… https://thecodexes.com/image-bank/plates/ECG-STEMI-ANT/ https://thecodexes.com/assets/MED-538757a4116a8d3c3908/original.jpg Anterior STEMI Anterior STEMI (ECG-STEMI-ANT) — Anterior STEMI: ST elevation V1–V4 with reciprocal inferior depression — LAD occlusion; cath lab, not serial troponins. — Free USMLE® Step 2 CK ImageBank plate with… https://thecodexes.com/image-bank/plates/ECG-STEMI-INF/ https://thecodexes.com/assets/MED-4a2ed2284cdefdf80d7b/original.jpg Inferior STEMI Inferior STEMI (ECG-STEMI-INF) — Inferior STEMI with RV involvement: ST elevation III > II and in V4R — preload-dependent; fluids, no nitrates. — Free USMLE® Step 2 CK ImageBank plate with source… https://thecodexes.com/image-bank/plates/ECG-SVT/ https://thecodexes.com/assets/MED-21e671d3ddc9c584627a/original.jpg AVNRT AVNRT (ECG-SVT) — AVNRT: regular narrow-complex tachycardia with buried P waves — vagal maneuvers, then adenosine. — Free USMLE® Step 2 CK ImageBank plate with source evidence and MyCodexes study… https://thecodexes.com/image-bank/plates/ECG-TORSADES/ https://thecodexes.com/assets/MED-00405c43db03bd8d0629/original.png Torsades de pointes Torsades de pointes (ECG-TORSADES) — Torsades is polymorphic VT associated with prolonged QT. Sustained episodes require immediate unsynchronized shock; give magnesium, correct electrolytes, and… https://thecodexes.com/image-bank/plates/ECG-VFIB/ https://thecodexes.com/assets/MED-773f71c35ee8be7fb974/original.jpg Ventricular fibrillation Ventricular fibrillation (ECG-VFIB) — Ventricular fibrillation: chaotic, disorganized electrical activity — immediate defibrillation. — Free USMLE® Step 2 CK ImageBank plate with source evidence and… https://thecodexes.com/image-bank/plates/ECG-VT/ https://thecodexes.com/assets/MED-23add7247360dcb0baad/original.png Ventricular tachycardia Ventricular tachycardia (ECG-VT) — Monomorphic VT: regular wide-complex tachycardia — unstable → synchronized cardioversion; stable → amiodarone/procainamide. — Free USMLE® Step 2 CK ImageBank plate… https://thecodexes.com/image-bank/plates/ECG-WPW/ https://thecodexes.com/assets/MED-7e2648b6bf3634b97483/original.jpg Wolff Parkinson White Wolff Parkinson White (ECG-WPW) — WPW: short PR interval with a slurred delta wave — avoid AV-nodal blockers if AF develops; procainamide or cardioversion. — Free USMLE® Step 2 CK ImageBank plate… https://thecodexes.com/image-bank/plates/ECHO-E2-080/ https://thecodexes.com/assets/MED-849bbc2c1b45d16d32c5/original.gif Large circumferential pericardial effusion with early diastolic right ventricular… Large circumferential pericardial effusion with early diastolic right ventricular… (ECHO-E2-080) — Pericardial effusion with chamber collapse supports tamponade physiology; assess perfusion and… https://thecodexes.com/image-bank/plates/EEG-B10-004/ https://thecodexes.com/assets/MED-b154ef85300b8531c8d1/original.png Hypsarrhythmia: chaotic, high-amplitude (>200 µV) multifocal spikes and slow waves… Hypsarrhythmia: chaotic, high-amplitude (>200 µV) multifocal spikes and slow waves… (EEG-B10-004) — Infant spasm clusters + regression + hypsarrhythmia → start hormonal therapy promptly, with workup… https://thecodexes.com/image-bank/plates/ENDO-E2-031a/ https://thecodexes.com/assets/MED-0b1a6e4c5db005de641c/original.jpg Esophagus with concentric rings (trachealization), longitudinal furrows, and white… Esophagus with concentric rings (trachealization), longitudinal furrows, and white… (ENDO-E2-031a) — Atopic young adult + food impaction + rings and furrows + ≥15 eos/HPF → PPI, swallowed topical… https://thecodexes.com/image-bank/plates/ENT-HEARING-TESTS/ https://thecodexes.com/assets/MED-c3ab2694a6ad55f00440/original.png Hearing tests and audiograms Hearing tests and audiograms (ENT-HEARING-TESTS) — Weber lateralizes to the conductive-loss ear or away from the sensorineural-loss ear; Rinne BC > AC means conductive loss. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/EYE-B08-008/ https://thecodexes.com/assets/MED-a84e85a6b68781a51321/original.png Mild NPDR: scattered microaneurysms and dot-blot hemorrhages in the posterior pole… Mild NPDR: scattered microaneurysms and dot-blot hemorrhages in the posterior pole… (EYE-B08-008) — Preexisting diabetes + pregnancy → dilated eye exam in first trimester, then every trimester and… https://thecodexes.com/image-bank/plates/EYE-B08-025/ https://thecodexes.com/assets/MED-8261184e385061b784d6/original.jpg Advanced glaucomatous cupping bilaterally, cup-to-disc ratio approximately 0.8 with… Advanced glaucomatous cupping bilaterally, cup-to-disc ratio approximately 0.8 with… (EYE-B08-025) — Open-angle glaucoma → prostaglandin analog first. Exception: asthma or COPD → avoid timolol; add… https://thecodexes.com/image-bank/plates/EYE-B08-027/ https://thecodexes.com/assets/MED-162812bc8af9208f6979/original.jpg CRAO: diffuse retinal whitening with a cherry-red spot at the fovea; arteritic variant… CRAO: diffuse retinal whitening with a cherry-red spot at the fovea; arteritic variant… (EYE-B08-027) — Retinal artery occlusion after age 50 + jaw claudication, polymyalgia, or pale disc edema →… https://thecodexes.com/image-bank/plates/EYE-BRVO/ https://thecodexes.com/image-bank/plates/EYE-CRAO/ https://thecodexes.com/assets/MED-44d2d8fccff575b8bcef/original.jpg Central retinal artery occlusion Central retinal artery occlusion (EYE-CRAO) — Central retinal artery occlusion causes sudden painless monocular vision loss with retinal pallor and a cherry-red spot. Arrange immediate stroke-center… https://thecodexes.com/image-bank/plates/EYE-CRVO/ https://thecodexes.com/assets/MED-1dad8867bcd39df66dc3/original.jpg Central retinal vein occlusion Central retinal vein occlusion (EYE-CRVO) — Central retinal vein occlusion: diffuse retinal hemorrhages in all quadrants ('blood and thunder') — hypertension, glaucoma, hyperviscosity; anti-VEGF for… https://thecodexes.com/image-bank/plates/EYE-DIABETIC-RETINOPATHY/ https://thecodexes.com/assets/MED-84f55fe05299c5a27648/original.jpg Diabetic retinopathy Diabetic retinopathy (EYE-DIABETIC-RETINOPATHY) — Diabetic retinopathy: microaneurysms, dot-blot hemorrhages and hard exudates; neovascularization marks proliferative disease — anti-VEGF or laser.… https://thecodexes.com/image-bank/plates/EYE-E1-137/ https://thecodexes.com/assets/MED-86c37f90a2180944be59/original.jpg Bilateral optic disc edema with blurred disc margins, elevation of the disc surface… Bilateral optic disc edema with blurred disc margins, elevation of the disc surface… (EYE-E1-137) — Bilateral papilledema + normal MRI/MRV in obese young woman → lumbar puncture opening pressure… https://thecodexes.com/image-bank/plates/EYE-HYPERTENSIVE-RETINOPATHY/ https://thecodexes.com/image-bank/plates/EYE-KAYSER-FLEISCHER/ https://thecodexes.com/assets/MED-47bbcf828b309b931f66/original.jpg Kayser Fleischer ring Kayser Fleischer ring (EYE-KAYSER-FLEISCHER) — Kayser-Fleischer ring: copper deposition in Descemet membrane — Wilson disease; low ceruloplasmin, high urinary copper; penicillamine or trientine… https://thecodexes.com/image-bank/plates/EYE-PAPILLEDEMA/ https://thecodexes.com/assets/MED-215f92df1bba9605b76e/original.jpg Papilledema fundus Papilledema fundus (EYE-PAPILLEDEMA) — Papilledema: elevated, blurred disc margins with obscured vessels — imaging before lumbar puncture; idiopathic intracranial hypertension in obese young women.… https://thecodexes.com/image-bank/plates/FHR-EARLY/ https://thecodexes.com/assets/MED-61772b20bc55dc6e38ee/original.webp Early fetal heart-rate decelerations Early fetal heart-rate decelerations (FHR-EARLY) — Early decelerations mirror the contraction (nadir at the peak) — fetal head compression; benign, no intervention. — Free USMLE® Step 2 CK ImageBank… https://thecodexes.com/image-bank/plates/FHR-LATE-DECEL/ https://thecodexes.com/assets/MED-aa5872fe570a0b94e95c/original.webp Late decelerations Late decelerations (FHR-LATE-DECEL) — Late decelerations suggest uteroplacental insufficiency. Reposition, stop oxytocin, correct hypotension or tachysystole, and give oxygen only for maternal… https://thecodexes.com/image-bank/plates/FHR-PROLONGED/ https://thecodexes.com/assets/MED-0377fdad8736c275d72e/original.webp Prolonged fetal heart-rate deceleration Prolonged fetal heart-rate deceleration (FHR-PROLONGED) — A prolonged fetal deceleration lasts 2 to less than 10 minutes; 10 minutes defines a baseline change. Begin immediate corrective measures… https://thecodexes.com/image-bank/plates/FHR-VARIABLE-DECEL/ https://thecodexes.com/assets/MED-f3a2e9083c186e145f33/original.webp Variable decelerations Variable decelerations (FHR-VARIABLE-DECEL) — Variable decelerations: abrupt V-shaped drops of variable timing — cord compression; amnioinfusion for recurrent variables. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/GI-UGIB-EGD/ https://thecodexes.com/assets/MED-0c0dfed54ecfa262f4f0/original.png Bleeding peptic ulcers on endoscopy Bleeding peptic ulcers on endoscopy (GI-UGIB-EGD) — Peptic ulcer bleeding: active bleeding or a visible vessel needs endoscopic therapy plus IV PPI; a clean ulcer base can be discharged early.… https://thecodexes.com/image-bank/plates/HISTO-B03-002/ https://thecodexes.com/assets/MED-43102110f62440b593a9/original.jpg Columnar epithelium with interspersed goblet cells (intestinal metaplasia) replacing… Columnar epithelium with interspersed goblet cells (intestinal metaplasia) replacing… (HISTO-B03-002) — Nondysplastic Barrett esophagus 3 cm or longer → endoscopy every 3 years with acid… https://thecodexes.com/image-bank/plates/HISTO-B06-004/ https://thecodexes.com/assets/MED-7b91ccc4bae914d88d17/original.jpg Diffuse sheets of intermediate-sized lymphoid cells with high mitotic index and… Diffuse sheets of intermediate-sized lymphoid cells with high mitotic index and… (HISTO-B06-004) — Child + rapidly enlarging ileocecal or jaw mass + starry-sky histology + high LDH and urate →… https://thecodexes.com/image-bank/plates/HISTO-BRONCHIAL-SQUAMOUS-METAPLASIA/ https://thecodexes.com/assets/MED-58e2169e73881308a023/original.jpg Bronchial squamous metaplasia — histology Bronchial squamous metaplasia — histology (HISTO-BRONCHIAL-SQUAMOUS-METAPLASIA) — Layered squamous epithelium replaces the ciliated pseudostratified respiratory lining; evaluate atypia separately.… https://thecodexes.com/image-bank/plates/HISTO-GASTRIC-MALT-LYMPHOMA/ https://thecodexes.com/assets/MED-d73f93a0b9774e02866a/original.png Gastric MALT lymphoma — lymphoepithelial lesions Gastric MALT lymphoma — lymphoepithelial lesions (HISTO-GASTRIC-MALT-LYMPHOMA) — Find small lymphocytes infiltrating and disrupting gastric glands; compare the low-power context with the high-power… https://thecodexes.com/image-bank/plates/HISTO-SARCOIDOSIS-SCHAUMANN/ https://thecodexes.com/assets/MED-8341891aa501f545137b/original.jpg Schaumann body in a sarcoid granuloma Schaumann body in a sarcoid granuloma (HISTO-SARCOIDOSIS-SCHAUMANN) — Identify the laminated inclusion in the giant cell; this plate shows the Schaumann component of the requested granuloma finding.… https://thecodexes.com/image-bank/plates/MICRO-AFB/ https://thecodexes.com/assets/MED-4b9aae666cd20e217957/original.jpg Acid fast bacilli Acid fast bacilli (MICRO-AFB) — Acid-fast bacilli on Ziehl-Neelsen stain: mycobacteria — NAAT confirms M. tuberculosis; culture for susceptibilities. — Free USMLE® Step 2 CK ImageBank plate with… https://thecodexes.com/image-bank/plates/MICRO-B09-004/ https://thecodexes.com/assets/MED-380808727e78e17a61b8/original.jpg Needle-shaped monosodium urate crystals appearing yellow when parallel to the slow… Needle-shaped monosodium urate crystals appearing yellow when parallel to the slow… (MICRO-B09-004) — Starting urate-lowering therapy → add colchicine, NSAID, or low-dose prednisone prophylaxis for… https://thecodexes.com/image-bank/plates/MICRO-GIARDIA/ https://thecodexes.com/assets/MED-69799800a29b0d19b836/original.jpg Giardia stool microscopy Giardia stool microscopy (MICRO-GIARDIA) — Giardia: oval cysts in stool (pear-shaped trophozoites); foul, fatty diarrhea after camping or daycare exposure — stool antigen/PCR; metronidazole or… https://thecodexes.com/image-bank/plates/MICRO-GRAM-GPC/ https://thecodexes.com/assets/MED-97c356c9098b60fb030b/original.jpg Gram positive cocci Gram positive cocci (MICRO-GRAM-GPC) — Gram-positive cocci in clusters suggest staphylococci. Confirm species and susceptibilities; suspected serious staphylococcal infection may require empiric… https://thecodexes.com/image-bank/plates/MONITOR-ARTERIAL-LINE/ https://thecodexes.com/assets/MED-a91de1db8c109e6c64a3/original.png Arterial-line pressure waveform Arterial-line pressure waveform (MONITOR-ARTERIAL-LINE) — Arterial line: sharp upstroke and dicrotic notch; a damped trace (flattened, no notch) under-reads systolic pressure — flush and check the… https://thecodexes.com/image-bank/plates/MONITOR-CVP/ https://thecodexes.com/assets/MED-7ee55d0d4762ec61ce4a/original.png Central venous pressure waveform Central venous pressure waveform (MONITOR-CVP) — CVP waveform: a, c, v waves with x and y descents; cannon a waves = AV dissociation, large v waves = tricuspid regurgitation; CVP alone poorly… https://thecodexes.com/image-bank/plates/MRI-B09-030/ https://thecodexes.com/assets/MED-3685350840ac1d046fd8/original.jpg Sagittal MRI lumbar spine showing an epidural mass compressing the cauda equina at the… Sagittal MRI lumbar spine showing an epidural mass compressing the cauda equina at the… (MRI-B09-030) — Saddle numbness + urinary retention + reduced anal tone → emergent MRI without and with… https://thecodexes.com/image-bank/plates/MRI-CAUDA/ https://thecodexes.com/assets/MED-ae7d2ddba7b65354e93f/original.png Cauda equina MRI Cauda equina MRI (MRI-CAUDA) — Cauda equina compression with bladder dysfunction, saddle sensory loss, or progressive deficits requires emergency MRI and urgent decompression as soon as feasible.… https://thecodexes.com/image-bank/plates/MRI-MS/ https://thecodexes.com/assets/MED-c225748e68f5b4ef3e08/original.png Multiple sclerosis MRI Multiple sclerosis MRI (MRI-MS) — Multiple sclerosis: periventricular ovoid T2/FLAIR lesions ('Dawson fingers') — dissemination in space and time by McDonald criteria. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/NEURO-HEAD-IMPULSE/ https://thecodexes.com/image-bank/plates/NEURO-VERTIGO-TESTS/ https://thecodexes.com/image-bank/plates/OB-HSG-TUBAL/ https://thecodexes.com/assets/MED-bab8700e5cd243491e3d/original.jpg Hysterosalpingography: tubal patency Hysterosalpingography: tubal patency (OB-HSG-TUBAL) — Hysterosalpingography: free spill of contrast confirms tubal patency; a dilated, non-spilling tube is a hydrosalpinx — first-line tubal test in… https://thecodexes.com/image-bank/plates/OB-HSG-UTERINE/ https://thecodexes.com/assets/MED-330318d189bad195077a/original.jpg Hysterosalpingography: uterine anomaly Hysterosalpingography: uterine anomaly (OB-HSG-UTERINE) — HSG shows the cavity but cannot reliably distinguish septate from bicornuate uterus; assess the external contour with 3D transvaginal… https://thecodexes.com/image-bank/plates/PEDS-FIFTH-DISEASE/ https://thecodexes.com/assets/MED-360041f1101193f13900/original.jpg Erythema infectiosum Erythema infectiosum (PEDS-FIFTH-DISEASE) — Erythema infectiosum (parvovirus B19): slapped cheeks then lacy limb rash — no longer contagious once the rash appears; risk of aplastic crisis in sickle… https://thecodexes.com/image-bank/plates/PEDS-ROSEOLA/ https://thecodexes.com/assets/MED-9ef4c38a2ab0131f5d8c/original.jpg Roseola infantum Roseola infantum (PEDS-ROSEOLA) — Roseola (HHV-6): 3–5 days of high fever, then a rash as the fever breaks — febrile seizures are the key complication; supportive care. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/PEDS-RUBELLA/ https://thecodexes.com/assets/MED-082f92a56a3ff111d419/original.jpg Rubella exanthem Rubella exanthem (PEDS-RUBELLA) — Rubella: mild face-to-trunk pink rash with posterior auricular/occipital nodes — main risk is congenital rubella; check immunity before pregnancy (MMR is live… https://thecodexes.com/image-bank/plates/PEDS-SCARLET-FEVER/ https://thecodexes.com/assets/MED-36874464a9e8fc322516/original.jpg Scarlet fever rash Scarlet fever rash (PEDS-SCARLET-FEVER) — Scarlet fever: sandpaper rash with Pastia lines and strawberry tongue after strep pharyngitis — penicillin or amoxicillin to prevent rheumatic fever. — Free… https://thecodexes.com/image-bank/plates/PEDS-THYMIC-SHADOW/ https://thecodexes.com/assets/MED-bca03afdf9ce9a6c6968/original.jpg Absent thymic shadow Absent thymic shadow (PEDS-THYMIC-SHADOW) — Absent thymic shadow with hypocalcemia and a conotruncal heart defect: DiGeorge (22q11.2 deletion) — check T cells and give irradiated blood products.… https://thecodexes.com/image-bank/plates/PEDS-VARICELLA/ https://thecodexes.com/assets/MED-2fc928fcf930e834bb08/original.jpg Varicella rash Varicella rash (PEDS-VARICELLA) — Varicella: crops of lesions in different stages (papule, vesicle, crust) — contagious until all crusted; acyclovir for adolescents, adults and the… https://thecodexes.com/image-bank/plates/PHOTO-ACANTHOSIS/ https://thecodexes.com/assets/MED-fa939abe72b0164d0567/original.jpg Acanthosis nigricans Acanthosis nigricans (PHOTO-ACANTHOSIS) — Acanthosis nigricans: velvety hyperpigmented neck and axillae — insulin resistance; abrupt onset in an older adult prompts a search for gastric… https://thecodexes.com/image-bank/plates/PHOTO-B04-021/ https://thecodexes.com/assets/MED-1d561f66cfa4c97170c6/original.jpg Lichtenberg figures: branching, fern-like erythematous pattern over the shoulder and… Lichtenberg figures: branching, fern-like erythematous pattern over the shoulder and… (PHOTO-B04-021) — Lightning strike + fern-like blanching erythema → direct-current asystole with respiratory… https://thecodexes.com/image-bank/plates/PHOTO-B04-041/ https://thecodexes.com/assets/MED-a3091314269a7af8b698/original.jpg Bilateral periorbital edema in a young child with nephrotic syndrome, most prominent… Bilateral periorbital edema in a young child with nephrotic syndrome, most prominent… (PHOTO-B04-041) — Child on high-dose prednisone for nephrotic syndrome → give inactivated vaccines now (PCV20… https://thecodexes.com/image-bank/plates/PHOTO-B08-002/ https://thecodexes.com/assets/MED-6bcbb065b31138ee8c14/original.jpg Normal otoscopy: intact translucent tympanic membrane with normal landmarks and no… Normal otoscopy: intact translucent tympanic membrane with normal landmarks and no… (PHOTO-B08-002) — Oscillopsia + bilateral abnormal head impulse test + high-frequency hearing loss during… https://thecodexes.com/image-bank/plates/PHOTO-B08-004/ https://thecodexes.com/assets/MED-2e78edf5e8c726a83433/original.jpg Right external auditory canal fully occluded by cerumen obscuring the tympanic membrane Right external auditory canal fully occluded by cerumen obscuring the tympanic membrane (PHOTO-B08-004) — Weber toward the affected ear + negative Rinne + canal full of cerumen → remove the cerumen.… https://thecodexes.com/image-bank/plates/PHOTO-B08-005/ https://thecodexes.com/assets/MED-b50eae626e2c9c2fc6be/original.png White pupillary reflex (leukocoria) in the right eye on flash photograph with absent… White pupillary reflex (leukocoria) in the right eye on flash photograph with absent… (PHOTO-B08-005) — Leukocoria or absent red reflex in an infant → urgent ophthalmology and dilated examination… https://thecodexes.com/image-bank/plates/PHOTO-B08-011/ https://thecodexes.com/assets/MED-744ea3190d9647266c16/original.jpg GAS pharyngitis: erythematous enlarged tonsils with white exudates and palatal petechiae GAS pharyngitis: erythematous enlarged tonsils with white exudates and palatal petechiae (PHOTO-B08-011) — Pharyngitis 2 to 4 weeks earlier + migratory polyarthritis + new mitral regurgitation →… https://thecodexes.com/image-bank/plates/PHOTO-B08-015/ https://thecodexes.com/assets/MED-1dc370e5daf810cd19c8/original.jpg AP neck radiograph steeple sign: symmetric subglottic tracheal narrowing; lateral view… AP neck radiograph steeple sign: symmetric subglottic tracheal narrowing; lateral view… (PHOTO-B08-015) — Croup with stridor at rest → dexamethasone + racemic epinephrine, observe 2 to 4 hours.… https://thecodexes.com/image-bank/plates/PHOTO-B08-019/ https://thecodexes.com/assets/MED-34c06291e736895873c2/original.png Ishihara plate testing showing impaired red-green color discrimination; visual field… Ishihara plate testing showing impaired red-green color discrimination; visual field… (PHOTO-B08-019) — Tuberculosis therapy + red-green color loss or central scotoma → stop ethambutol now and refer… https://thecodexes.com/image-bank/plates/PHOTO-B08-020/ https://thecodexes.com/assets/MED-71c9e5b10eb2a188f05f/original.jpg Central corneal white-yellow stromal infiltrate with overlying epithelial defect and… Central corneal white-yellow stromal infiltrate with overlying epithelial defect and… (PHOTO-B08-020) — Contact lens wearer + stromal infiltrate ± hypopyon → bacterial keratitis; culture and… https://thecodexes.com/image-bank/plates/PHOTO-B08-028/ https://thecodexes.com/assets/MED-6f56d43cf0b926b8560b/original.jpg Bulging, erythematous, opaque right tympanic membrane with obscured landmarks and… Bulging, erythematous, opaque right tympanic membrane with obscured landmarks and… (PHOTO-B08-028) — Acute otitis media + purulent conjunctivitis or amoxicillin in past 30 days →… https://thecodexes.com/image-bank/plates/PHOTO-B08-036/ https://thecodexes.com/assets/MED-6e1be820470b6d2055a0/original.jpg Lateral neck radiograph thumb sign: enlarged rounded epiglottis with thickened… Lateral neck radiograph thumb sign: enlarged rounded epiglottis with thickened… (PHOTO-B08-036) — Drooling + tripod + stridor without cough + thumb sign → keep upright, no IV or tongue depressor… https://thecodexes.com/image-bank/plates/PHOTO-B08-041/ https://thecodexes.com/assets/MED-7c3fef4abc9fb33bd7eb/original.jpg Fluorescein staining under cobalt blue light showing a well-demarcated, bright green… Fluorescein staining under cobalt blue light showing a well-demarcated, bright green… (PHOTO-B08-041) — Corneal abrasion without contact lens use → topical antibiotic, no patch; always evert the… https://thecodexes.com/image-bank/plates/PHOTO-B08-042/ https://thecodexes.com/assets/MED-a07e48da53b857534602/original.jpg Right Horner syndrome: mild right upper lid ptosis and right miosis with anisocoria… Right Horner syndrome: mild right upper lid ptosis and right miosis with anisocoria… (PHOTO-B08-042) — New Horner syndrome + ipsilateral neck or face pain → urgent CTA or MRA for carotid dissection.… https://thecodexes.com/image-bank/plates/PHOTO-B09-005/ https://thecodexes.com/assets/MED-c9c7a4515c7333cdafde/original.jpg Heliotrope rash: violaceous edematous discoloration of the upper eyelids; Gottron… Heliotrope rash: violaceous edematous discoloration of the upper eyelids; Gottron… (PHOTO-B09-005) — Anti-Jo-1 + mechanic's hands + ILD -> antisynthetase syndrome; ILD, not CK, drives prognosis.… https://thecodexes.com/image-bank/plates/PHOTO-B09-009/ https://thecodexes.com/assets/MED-44dd8768f5084cd85761/original.jpg Pearly translucent papule with rolled telangiectatic border and central ulceration on… Pearly translucent papule with rolled telangiectatic border and central ulceration on… (PHOTO-B09-009) — BCC on the nose or another H-zone facial site -> Mohs micrographic surgery for the highest… https://thecodexes.com/image-bank/plates/PHOTO-B09-010/ https://thecodexes.com/assets/MED-828de9070f4fe65e7666/original.jpg Gottron papules: flat-topped violaceous scaly papules over MCP and PIP joints of… Gottron papules: flat-topped violaceous scaly papules over MCP and PIP joints of… (PHOTO-B09-010) — New dermatomyositis with anti-TIF1-γ, age over 40, or weight loss → CT chest, abdomen, and pelvis… https://thecodexes.com/image-bank/plates/PHOTO-B09-012/ https://thecodexes.com/assets/MED-5ecc88bcc6874558ced3/original.jpg Nodulocystic acne with deep inflammatory nodules and pseudocysts on jawline and cheeks… Nodulocystic acne with deep inflammatory nodules and pseudocysts on jawline and cheeks… (PHOTO-B09-012) — Scarring nodular acne after failed oral antibiotic → isotretinoin; stop tetracyclines first.… https://thecodexes.com/image-bank/plates/PHOTO-B09-013/ https://thecodexes.com/assets/MED-73ef001d202d5dcaabe3/original.jpg Nodular melanoma: uniformly dark, dome-shaped nodule lacking asymmetry or border… Nodular melanoma: uniformly dark, dome-shaped nodule lacking asymmetry or border… (PHOTO-B09-013) — Rapidly growing, symmetric, uniformly dark nodule that lacks ABCDE features -> nodular melanoma… https://thecodexes.com/image-bank/plates/PHOTO-B09-014/ https://thecodexes.com/assets/MED-585f8864ada0d58d224f/original.jpg Typical three-zone target lesions (dusky center, pale edematous ring, erythematous… Typical three-zone target lesions (dusky center, pale edematous ring, erythematous… (PHOTO-B09-014) — Recurrent acral target lesions 1–2 weeks after cold sores → continuous valacyclovir for at least… https://thecodexes.com/image-bank/plates/PHOTO-B09-022/ https://thecodexes.com/assets/MED-01a8a29dbe37d764bf84/original.jpg Phalen test: right wrist flexion at 90 degrees held for 60 seconds reproducing… Phalen test: right wrist flexion at 90 degrees held for 60 seconds reproducing… (PHOTO-B09-022) — Night-predominant thumb/index/middle numbness plus positive Phalen/Tinel signs point to carpal… https://thecodexes.com/image-bank/plates/PHOTO-B09-026/ https://thecodexes.com/assets/MED-83f1a853a472bb9ed8d8/original.jpg Thin linear gray-white burrows 3 to 8 mm long in the finger web spaces and wrist, with… Thin linear gray-white burrows 3 to 8 mm long in the finger web spaces and wrist, with… (PHOTO-B09-026) — Nocturnal itch + web-space burrows + itchy household contacts → scabies; treat patient and… https://thecodexes.com/image-bank/plates/PHOTO-B09-028/ https://thecodexes.com/assets/MED-d8910c7afbb8c68c6706/original.jpg Erysipelas of the lower leg with sharply demarcated, raised, bright red border and… Erysipelas of the lower leg with sharply demarcated, raised, bright red border and… (PHOTO-B09-028) — Sharply demarcated, raised, spreading plaque without purulence → oral penicillin or cephalexin… https://thecodexes.com/image-bank/plates/PHOTO-B09-031/ https://thecodexes.com/assets/MED-69fe51714abc944fa324/original.jpg Synovial fluid comparison showing turbid, purulent fluid characteristic of septic… Synovial fluid comparison showing turbid, purulent fluid characteristic of septic… (PHOTO-B09-031) — Suspected septic arthritis requires prompt arthrocentesis with cell count, Gram stain, culture… https://thecodexes.com/image-bank/plates/PHOTO-B09-042/ https://thecodexes.com/assets/MED-a7e01089de9048fcd91b/original.jpg Flaccid, thin-roofed bullae and erosions on the trunk with erosive lesions of the… Flaccid, thin-roofed bullae and erosions on the trunk with erosive lesions of the… (PHOTO-B09-042) — Oral erosions + flaccid bullae + erosion with lateral pressure → pemphigus vulgaris →… https://thecodexes.com/image-bank/plates/PHOTO-B09-043/ https://thecodexes.com/assets/MED-5ae065852d9e61cda4b8/original.jpg Solitary well-demarcated dusky violaceous plaque with central bulla recurring at the… Solitary well-demarcated dusky violaceous plaque with central bulla recurring at the… (PHOTO-B09-043) — Same lesion, same site, every exposure → fixed drug eruption → epidermal CD8+ T-cell-mediated… https://thecodexes.com/image-bank/plates/PHOTO-B09-045/ https://thecodexes.com/assets/MED-d489ec760bce07a38516/original.jpg Monomorphic punched-out erosions and hemorrhagic crusted vesicles superimposed on… Monomorphic punched-out erosions and hemorrhagic crusted vesicles superimposed on… (PHOTO-B09-045) — Fever and monomorphic punched-out vesicles or erosions on eczema suggest eczema herpeticum: begin… https://thecodexes.com/image-bank/plates/PHOTO-B10-009/ https://thecodexes.com/assets/MED-e5770dac142bc449dcee/original.jpg Jaundiced term newborn with cephalocaudal yellow discoloration extending to the chest;… Jaundiced term newborn with cephalocaudal yellow discoloration extending to the chest;… (PHOTO-B10-009) — Use age-, gestation-, and neurotoxicity-risk-adjusted bilirubin thresholds. At escalation… https://thecodexes.com/image-bank/plates/PHOTO-B10-014/ https://thecodexes.com/assets/MED-eeca96f674401dc60a4b/original.jpg Palpable, non-blanching purpuric papules and plaques concentrated on the buttocks and… Palpable, non-blanching purpuric papules and plaques concentrated on the buttocks and… (PHOTO-B10-014) — IgA vasculitis with severe abdominal pain (intussusception excluded) → oral corticosteroids.… https://thecodexes.com/image-bank/plates/PHOTO-B10-015/ https://thecodexes.com/assets/MED-7223e435a17f3e3b6fad/original.png Russell sign: calluses and abrasions over the dorsal MCP joints of the dominant hand Russell sign: calluses and abrasions over the dorsal MCP joints of the dominant hand (PHOTO-B10-015) — Adolescent purging + K⁺ <3.0 mEq/L, QTc prolongation, or arrhythmia → admit for telemetry and… https://thecodexes.com/image-bank/plates/PHOTO-B10-019/ https://thecodexes.com/assets/MED-32479b1d2c7c8bf52c79/original.png Hypopigmented ash-leaf macules on the trunk, accentuated under Wood lamp Hypopigmented ash-leaf macules on the trunk, accentuated under Wood lamp (PHOTO-B10-019) — Infantile spasms + tuberous sclerosis → vigabatrin first, with visual field monitoring. Exception… https://thecodexes.com/image-bank/plates/PHOTO-B10-024/ https://thecodexes.com/assets/MED-1853c09faaf95aad257a/original.jpg Bilateral non-purulent bulbar conjunctival injection with limbic sparing and diffuse… Bilateral non-purulent bulbar conjunctival injection with limbic sparing and diffuse… (PHOTO-B10-024) — Infants with persistent fever may have incomplete Kawasaki disease. Evaluate inflammatory… https://thecodexes.com/image-bank/plates/PHOTO-B11-040/ https://thecodexes.com/assets/MED-bb316c30734e76af7a8e/original.jpg Erythematous, edematous urticarial papules and plaques within the abdominal striae,… Erythematous, edematous urticarial papules and plaques within the abdominal striae,… (PHOTO-B11-040) — Primigravida, third trimester, itchy plaques in striae sparing umbilicus → PUPPP → topical… https://thecodexes.com/image-bank/plates/PHOTO-CLUBBING/ https://thecodexes.com/assets/MED-6503d4e5816dfc7f60b4/original.jpg Digital clubbing Digital clubbing (PHOTO-CLUBBING) — Digital clubbing: lost nail-fold angle — lung cancer, bronchiectasis, cystic fibrosis, cyanotic heart disease, IBD; not COPD. — Free USMLE® Step 2 CK ImageBank… https://thecodexes.com/image-bank/plates/PHOTO-CUSHING/ https://thecodexes.com/assets/MED-dfafdaeb6f4831be28e3/original.jpg Cushing syndrome Cushing syndrome (PHOTO-CUSHING) — Cushing syndrome: central adiposity, facial plethora, proximal weakness and wide violaceous striae — screen with late-night salivary cortisol, 1-mg dexamethasone… https://thecodexes.com/image-bank/plates/PHOTO-DVT/ https://thecodexes.com/assets/MED-54c9916d65cb2067de94/original.jpg Deep vein thrombosis Deep vein thrombosis (PHOTO-DVT) — Unilateral calf swelling >3 cm: DVT — Wells score, D-dimer if low probability, compression ultrasound; anticoagulate for ≥3 months. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/PHOTO-E1-008/ https://thecodexes.com/assets/MED-a74f8951aa83a98ba6fe/original.jpg Hypopigmented, oval ash-leaf macule on the trunk of an infant, accentuated… Hypopigmented, oval ash-leaf macule on the trunk of an infant, accentuated… (PHOTO-E1-008) — Three or more hypomelanotic macules at least 5 mm across constitute one major TSC feature. Infantile… https://thecodexes.com/image-bank/plates/PHOTO-E1-011/ https://thecodexes.com/assets/MED-96f69e0640bd934a53fe/original.jpg Multiple dome-shaped, flesh-colored papules with central umbilication and an… Multiple dome-shaped, flesh-colored papules with central umbilication and an… (PHOTO-E1-011) — Umbilicated pearly papules with a cheesy core → poxvirus in keratinocytes; observation is acceptable.… https://thecodexes.com/image-bank/plates/PHOTO-E1-015/ https://thecodexes.com/assets/MED-385099e68a44e80082b3/original.jpg Well-demarcated oval patch of complete, non-scarring hair loss on the vertex scalp… Well-demarcated oval patch of complete, non-scarring hair loss on the vertex scalp… (PHOTO-E1-015) — Smooth oval patch of complete hair loss + exclamation-point hairs ± nail pits → alopecia areata… https://thecodexes.com/image-bank/plates/PHOTO-E1-022/ https://thecodexes.com/assets/MED-2d263cb2d3004305c183/original.jpg Multiple target lesions with three concentric zones (dusky central bulla, pale… Multiple target lesions with three concentric zones (dusky central bulla, pale… (PHOTO-E1-022) — Recurrent acral target lesions without mucosal disease → erythema multiforme; ask about cold sores.… https://thecodexes.com/image-bank/plates/PHOTO-E1-091/ https://thecodexes.com/assets/MED-fc03727e52f6e55417f1/original.jpg Flat-topped violaceous polygonal papules with white lacy Wickham striae on the flexor… Flat-topped violaceous polygonal papules with white lacy Wickham striae on the flexor… (PHOTO-E1-091) — Pruritic purple polygonal flat papules + Wickham striae + oral lacy lesions ± hepatitis C →… https://thecodexes.com/image-bank/plates/PHOTO-E1-100/ https://thecodexes.com/assets/MED-de22a1a5aeeb1ed76255/original.jpg Indurated violaceous plaques over the nose, nasal alae, and cheeks (lupus pernio) in a… Indurated violaceous plaques over the nose, nasal alae, and cheeks (lupus pernio) in a… (PHOTO-E1-100) — Sarcoidosis with impaired lung function or hypercalcemia with kidney injury → oral… https://thecodexes.com/image-bank/plates/PHOTO-E1-125/ https://thecodexes.com/assets/MED-500c54d9cb96000bb629/original.jpg Multiple violaceous oval nonblanching plaques and nodules on the lower legs along skin… Multiple violaceous oval nonblanching plaques and nodules on the lower legs along skin… (PHOTO-E1-125) — Violaceous plaques in HIV → punch biopsy with HHV-8 LANA-1 and Warthin-Starry stains.… https://thecodexes.com/image-bank/plates/PHOTO-E1-152/ https://thecodexes.com/assets/MED-b0ae98f7ec71391c2dcc/original.jpg Hot tub folliculitis: erythematous follicular papules and pustules on buttocks and… Hot tub folliculitis: erythematous follicular papules and pustules on buttocks and… (PHOTO-E1-152) — Hot-tub-associated follicular pustules in an otherwise well patient usually resolve without… https://thecodexes.com/image-bank/plates/PHOTO-E1-162/ https://thecodexes.com/assets/MED-d554e1a9f8e7d6bed7a2/original.jpg Firm hyperpigmented nodule extending beyond the margins of the original ear-piercing… Firm hyperpigmented nodule extending beyond the margins of the original ear-piercing… (PHOTO-E1-162) — Scar extending beyond the original wound after trauma at a typical site → clinical keloid… https://thecodexes.com/image-bank/plates/PHOTO-E1-173/ https://thecodexes.com/assets/MED-41d6da30d050e6b74f54/original.jpg Symmetric grouped small tense vesicles with excoriated crusted erosions on extensor… Symmetric grouped small tense vesicles with excoriated crusted erosions on extensor… (PHOTO-E1-173) — Itchy grouped extensor vesicles + papillary neutrophils → dermatitis herpetiformis: check… https://thecodexes.com/image-bank/plates/PHOTO-E1-182/ https://thecodexes.com/assets/MED-8251fc81d06c3c83c4d8/original.jpg Actinic cheilitis with diffuse scaling, erythema, and pallor of the lower lip… Actinic cheilitis with diffuse scaling, erythema, and pallor of the lower lip… (PHOTO-E1-182) — Non-healing, indurated, or ulcerated lesion within actinic cheilitis → biopsy before any treatment.… https://thecodexes.com/image-bank/plates/PHOTO-E1-183/ https://thecodexes.com/assets/MED-5840746029bd3e42b57e/original.jpg Multiple uniform light-brown café-au-lait macules on the trunk with soft pedunculated… Multiple uniform light-brown café-au-lait macules on the trunk with soft pedunculated… (PHOTO-E1-183) — Child meeting NF1 criteria → annual ophthalmologic examination plus yearly blood pressure… https://thecodexes.com/image-bank/plates/PHOTO-E1-215/ https://thecodexes.com/assets/MED-b2e1906ff6c745c60342/original.jpg Sclerodactyly with taut, shiny, bound-down skin over the fingers and limited flexion… Sclerodactyly with taut, shiny, bound-down skin over the fingers and limited flexion… (PHOTO-E1-215) — Raynaud phenomenon with sclerodactyly or pitting scars → nailfold capillaroscopy to show… https://thecodexes.com/image-bank/plates/PHOTO-E1-230/ https://thecodexes.com/assets/MED-109797d5bcb684b11836/original.jpg Waxy yellow-brown atrophic plaque with telangiectatic thinned center and a raised… Waxy yellow-brown atrophic plaque with telangiectatic thinned center and a raised… (PHOTO-E1-230) — Waxy yellow-brown shin plaque with atrophic telangiectatic center in diabetes → potent topical… https://thecodexes.com/image-bank/plates/PHOTO-E1-279/ https://thecodexes.com/assets/MED-14e01f1fc24306e61708/original.jpg Discoid lupus erythematosus: atrophic hypopigmented plaques with hyperpigmented rims… Discoid lupus erythematosus: atrophic hypopigmented plaques with hyperpigmented rims… (PHOTO-E1-279) — Hydroxychloroquine requires baseline fundus, OCT, and fundus autofluorescence assessment.… https://thecodexes.com/image-bank/plates/PHOTO-E1-283/ https://thecodexes.com/assets/MED-3e064623c9b0b7fda517/original.jpg Erythematous patches with greasy yellowish scale over the nasolabial folds, eyebrows,… Erythematous patches with greasy yellowish scale over the nasolabial folds, eyebrows,… (PHOTO-E1-283) — Greasy yellow scale on nasolabial folds, eyebrows, and scalp → seborrheic dermatitis → topical… https://thecodexes.com/image-bank/plates/PHOTO-E1-286/ https://thecodexes.com/assets/MED-1324f45ce68120a00c1e/original.jpg Bilateral diffuse, tender parotid swelling extending anterior to and below the ear Bilateral diffuse, tender parotid swelling extending anterior to and below the ear (PHOTO-E1-286) — Bilateral parotitis + orchitis in an unvaccinated adolescent → mumps; buccal swab RT-PCR… https://thecodexes.com/image-bank/plates/PHOTO-E1-363/ https://thecodexes.com/assets/MED-61f2d8ad13ae0f65686d/original.jpg Great toenail with yellow-brown discoloration, subungual hyperkeratosis with crumbly… Great toenail with yellow-brown discoloration, subungual hyperkeratosis with crumbly… (PHOTO-E1-363) — Thick, discolored toenails with subungual debris → confirm fungus (KOH, culture, or PAS) before… https://thecodexes.com/image-bank/plates/PHOTO-GRAVES-EYE/ https://thecodexes.com/assets/MED-2c6cfb72cfe11b05ec96/original.jpg Graves orbitopathy Graves orbitopathy (PHOTO-GRAVES-EYE) — Graves orbitopathy: proptosis and lid retraction, unique to Graves — TSI/TRAb; radioiodine can worsen eye disease, so steroids cover it or methimazole/surgery… https://thecodexes.com/image-bank/plates/PHOTO-HERPES-KERATITIS/ https://thecodexes.com/assets/MED-175efb76f00711593d46/original.jpg HSV dendritic keratitis HSV dendritic keratitis (PHOTO-HERPES-KERATITIS) — An HSV dendritic epithelial ulcer requires antiviral therapy; topical steroids are contraindicated during active epithelial ulceration. Stromal HSV… https://thecodexes.com/image-bank/plates/PHOTO-HSP/ https://thecodexes.com/assets/MED-1755d9dcf4b6f9af5c89/original.jpg IgA vasculitis purpura IgA vasculitis purpura (PHOTO-HSP) — Palpable purpura on the legs and buttocks in a child: IgA vasculitis (HSP) — check urinalysis for nephritis; supportive care, steroids for severe abdominal or… https://thecodexes.com/image-bank/plates/PHOTO-KAWASAKI/ https://thecodexes.com/assets/MED-3c0f02f0a8227c17d3fa/original.jpg Kawasaki disease Kawasaki disease (PHOTO-KAWASAKI) — Kawasaki disease: ≥5 days of fever with conjunctivitis, oral changes, rash, extremity changes, cervical node — IVIG plus aspirin within 10 days; echo for coronary… https://thecodexes.com/image-bank/plates/PHOTO-MALAR-RASH/ https://thecodexes.com/assets/MED-6d91cdf6ce48d830b992/original.jpg Malar rash lupus Malar rash lupus (PHOTO-MALAR-RASH) — Malar rash that spares the nasolabial folds: SLE — ANA screen, then anti-dsDNA/anti-Smith; hydroxychloroquine for everyone. — Free USMLE® Step 2 CK ImageBank… https://thecodexes.com/image-bank/plates/RAD-FULL-THICKNESS-SUPRASPINATUS-TEAR/ https://thecodexes.com/assets/MED-77a5c6fabc0cef374a67/original.webp Full-thickness supraspinatus tear (rotator cuff tear) Full-thickness supraspinatus tear (rotator cuff tear) (RAD-FULL-THICKNESS-SUPRASPINATUS-TEAR) — MRI shows discontinuity and retraction of supraspinatus tendon fibers with fluid signal gap at the… https://thecodexes.com/image-bank/plates/RAD-MESOTHELIOMA-PLEURAL-CT/ https://thecodexes.com/assets/MED-8a90981ea997f97ab46c/original.jpg Pleural mesothelioma — chest CT Pleural mesothelioma — chest CT (RAD-MESOTHELIOMA-PLEURAL-CT) — Trace the mass along the pleural surface rather than treating it as a central lung nodule; the left hemithorax is contracted. — Free… https://thecodexes.com/image-bank/plates/RAD-PML-T2-T1-MRI/ https://thecodexes.com/assets/MED-960e8acd079a52af7be2/original.jpg Progressive multifocal leukoencephalopathy — MRI Progressive multifocal leukoencephalopathy — MRI (RAD-PML-T2-T1-MRI) — The T2-bright white-matter lesion reaches the subcortical region; a corresponding T1-dark area appears in the second panel.… https://thecodexes.com/image-bank/plates/SKIN-ATOPIC/ https://thecodexes.com/assets/MED-8e17212f28776867b62e/original.jpg Atopic dermatitis Atopic dermatitis (SKIN-ATOPIC) — Atopic dermatitis: pruritic, lichenified flexural plaques in a child with asthma or allergic rhinitis — emollients and topical steroids; watch for eczema… https://thecodexes.com/image-bank/plates/SKIN-BCC/ https://thecodexes.com/assets/MED-023caf332a7a86d0118f/original.jpg Basal cell carcinoma Basal cell carcinoma (SKIN-BCC) — Basal cell carcinoma: pearly, telangiectatic papule with a rolled edge on sun-exposed skin — locally destructive, rarely metastasizes; Mohs on the face. — Free… https://thecodexes.com/image-bank/plates/SKIN-CELLULITIS-ERYSIPELAS/ https://thecodexes.com/assets/MED-7f870cb42121d5b2bed6/original.jpg Erysipelas Erysipelas (SKIN-CELLULITIS-ERYSIPELAS) — Erysipelas: raised, sharply demarcated fiery erythema (group A strep) versus cellulitis's indistinct border — beta-lactam; add MRSA cover only for purulence… https://thecodexes.com/image-bank/plates/SKIN-EM-LYME/ https://thecodexes.com/assets/MED-17549c77f45c5f57b642/original.jpg Erythema migrans Erythema migrans (SKIN-EM-LYME) — Erythema migrans: expanding target lesion ≥5 cm days after a tick bite — clinical diagnosis; doxycycline, no serology needed at this stage. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/SKIN-ERYTHEMA-NODOSUM/ https://thecodexes.com/assets/MED-99ea7e06ab99efbd217f/original.jpg Erythema nodosum Erythema nodosum (SKIN-ERYTHEMA-NODOSUM) — Erythema nodosum: tender shin nodules — look for sarcoidosis, streptococcal infection, IBD, TB, OCPs; treat the cause plus NSAIDs. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/SKIN-HFMD/ https://thecodexes.com/assets/MED-209dfa9d757699413440/original.jpg Hand foot mouth disease Hand foot mouth disease (SKIN-HFMD) — Hand-foot-and-mouth disease (coxsackie A16): grey-oval vesicles on palms, soles and mouth — supportive care. — Free USMLE® Step 2 CK ImageBank plate with source… https://thecodexes.com/image-bank/plates/SKIN-KAPOSI/ https://thecodexes.com/assets/MED-13c6ef2e6f249f8e0d8a/original.jpg Kaposi sarcoma Kaposi sarcoma (SKIN-KAPOSI) — Kaposi sarcoma: violaceous macules and nodules in HIV (HHV-8) — antiretroviral therapy is the first treatment. — Free USMLE® Step 2 CK ImageBank plate with source… https://thecodexes.com/image-bank/plates/SKIN-MEASLES/ https://thecodexes.com/image-bank/plates/SKIN-MELANOMA/ https://thecodexes.com/assets/MED-5dcb0c9f4fd32dbc3897/original.jpg Melanoma skin Melanoma skin (SKIN-MELANOMA) — A changing suspicious pigmented lesion warrants a complete, adequately deep biopsy with narrow margins when feasible. Elliptical excision, punch excision, or deep… https://thecodexes.com/image-bank/plates/SKIN-NEC-FASC/ https://thecodexes.com/assets/MED-a05cc9fbf921bc278471/original.jpg Necrotizing fasciitis Necrotizing fasciitis (SKIN-NEC-FASC) — Necrotizing fasciitis: pain out of proportion, then dusky skin, bullae and crepitus — surgical exploration is the diagnosis; imaging must never delay the OR.… https://thecodexes.com/image-bank/plates/SKIN-NEONATAL-JAUNDICE/ https://thecodexes.com/assets/MED-d6d9c480439c8cf1cb38/original.jpg Neonatal jaundice Neonatal jaundice (SKIN-NEONATAL-JAUNDICE) — Neonatal jaundice: phototherapy thresholds by hour-of-life and risk; jaundice in the first 24 h is always pathologic. — Free USMLE® Step 2 CK ImageBank… https://thecodexes.com/image-bank/plates/SKIN-PEMPHIGUS-BP/ https://thecodexes.com/assets/MED-c8c74f9c3a29665ed537/original.jpg Bullous pemphigoid and pemphigus Bullous pemphigoid and pemphigus (SKIN-PEMPHIGUS-BP) — Tense bullae in the elderly = bullous pemphigoid (subepidermal, Nikolsky negative); flaccid blisters and oral erosions = pemphigus vulgaris… https://thecodexes.com/image-bank/plates/SKIN-PRESSURE-ULCER/ https://thecodexes.com/assets/MED-7e39138f27fcb401266a/original.jpg Pressure ulcer Pressure ulcer (SKIN-PRESSURE-ULCER) — Full-thickness pressure injury: stage 3 exposes subcutaneous fat, stage 4 exposes bone/tendon/muscle — offloading, moisture control, debridement of necrosis.… https://thecodexes.com/image-bank/plates/SKIN-PSORIASIS/ https://thecodexes.com/assets/MED-546c854386980bcdce5a/original.jpg Plaque psoriasis Plaque psoriasis (SKIN-PSORIASIS) — Plaque psoriasis: sharply demarcated salmon plaques with silvery scale on extensor surfaces; pitting nails — topical steroids/vitamin D analogues, biologics for… https://thecodexes.com/image-bank/plates/SKIN-SCABIES/ https://thecodexes.com/image-bank/plates/SKIN-SCC/ https://thecodexes.com/assets/MED-bfb62c0fa250b71a72c1/original.jpg Squamous cell carcinoma Squamous cell carcinoma (SKIN-SCC) — Squamous cell carcinoma: scaly, crusted, indurated nodule — arises from actinic keratosis, chronic wounds and scars; can metastasize. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/SKIN-SJS-TEN/ https://thecodexes.com/assets/MED-3b5b5dd7c3bd23f4e219/original.jpg Stevens Johnson syndrome Stevens Johnson syndrome (SKIN-SJS-TEN) — SJS/TEN: dusky macules coalescing into sheets of epidermal detachment with mucosal erosions — stop the drug, burn-unit care; <10% BSA is SJS, >30% is TEN.… https://thecodexes.com/image-bank/plates/SKIN-TINEA/ https://thecodexes.com/assets/MED-fe94461d6d51d9db0b3e/original.jpg Tinea corporis Tinea corporis (SKIN-TINEA) — Tinea corporis: annular plaque with an advancing scaly edge and central clearing — KOH shows hyphae; topical azole, oral terbinafine for scalp or nails. — Free USMLE®… https://thecodexes.com/image-bank/plates/SKIN-ZOSTER/ https://thecodexes.com/assets/MED-7b4ba77ac98f6096e804/original.jpg Herpes zoster Herpes zoster (SKIN-ZOSTER) — Herpes zoster: grouped vesicles confined to one dermatome that does not cross midline — valacyclovir within 72 h; vaccinate adults ≥50 with recombinant zoster vaccine.… https://thecodexes.com/image-bank/plates/SMEAR-AML-AUER/ https://thecodexes.com/assets/MED-7c40bea8c7b03f20612d/original.jpg Auer rods AML Auer rods AML (SMEAR-AML-AUER) — Auer rods inside blasts: acute myeloid leukemia — APL (t(15;17)) presents with DIC and is treated with all-trans retinoic acid. — Free USMLE® Step 2 CK ImageBank… https://thecodexes.com/image-bank/plates/SMEAR-B06-008/ https://thecodexes.com/assets/MED-7dcaad2d629a943df79e/original.jpg Numerous lymphoblasts: large cells with scant cytoplasm, fine immature chromatin,… Numerous lymphoblasts: large cells with scant cytoplasm, fine immature chromatin,… (SMEAR-B06-008) — ALL with WBC ≥100,000/mm³ or hyperuricemia before chemotherapy → hydration + rasburicase.… https://thecodexes.com/image-bank/plates/SMEAR-B06-041/ https://thecodexes.com/assets/MED-2b9d324d17f3c8d09587/original.jpg Numerous schistocytes (helmet cells, triangular fragmented red cells) with markedly… Numerous schistocytes (helmet cells, triangular fragmented red cells) with markedly… (SMEAR-B06-041) — Fragmented red cells + platelets <30,000/mm³ + normal PT/PTT/fibrinogen + minimal renal injury… https://thecodexes.com/image-bank/plates/SMEAR-CLL-SMUDGE/ https://thecodexes.com/assets/MED-ad4dfffc9bdbca928752/original.jpg CLL smudge cells CLL smudge cells (SMEAR-CLL-SMUDGE) — CLL: sheets of small mature lymphocytes with smudge cells in an older adult with lymphocytosis — confirm with flow cytometry; observe until symptomatic. — Free… https://thecodexes.com/image-bank/plates/SMEAR-IDA/ https://thecodexes.com/assets/MED-dffbd965e86017365266/original.jpg Iron deficiency smear Iron deficiency smear (SMEAR-IDA) — Iron deficiency: microcytic, hypochromic cells with marked anisocytosis (high RDW) and pencil cells — low ferritin confirms; find the bleeding source. — Free… https://thecodexes.com/image-bank/plates/SMEAR-MALARIA/ https://thecodexes.com/assets/MED-2cf8e29107f4572c5085/original.jpg Malaria blood smear Malaria blood smear (SMEAR-MALARIA) — Intraerythrocytic ring forms: malaria (thick and thin smears; falciparum gets IV artesunate if severe) — Babesia's Maltese cross is the tick-borne mimic. — Free… https://thecodexes.com/image-bank/plates/SMEAR-MEGALOBLASTIC/ https://thecodexes.com/assets/MED-519ceab4e99b6c4c0298/original.jpg Megaloblastic anemia smear Megaloblastic anemia smear (SMEAR-MEGALOBLASTIC) — Megaloblastic anemia: macro-ovalocytes with hypersegmented neutrophils — B12 vs folate decided by methylmalonic acid; replace B12 before folate.… https://thecodexes.com/image-bank/plates/SMEAR-REED-STERNBERG/ https://thecodexes.com/assets/MED-59cc5af9c9f0d8564e14/original.jpg Reed Sternberg cell Reed Sternberg cell (SMEAR-REED-STERNBERG) — Reed-Sternberg cells in the appropriate tissue background and immunophenotype support classical Hodgkin lymphoma; look-alike cells occur in other… https://thecodexes.com/image-bank/plates/SMEAR-SCHISTOCYTES/ https://thecodexes.com/assets/MED-19a308c300bf29db30bb/original.jpg Schistocytes blood smear Schistocytes blood smear (SMEAR-SCHISTOCYTES) — Schistocytes: fragmented helmet cells of microangiopathic hemolysis — TTP (plasma exchange), HUS, DIC (treat the cause). — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/SMEAR-SICKLE/ https://thecodexes.com/assets/MED-ead8bade0fd9a5ae4ca5/original.jpg Sickle cell smear Sickle cell smear (SMEAR-SICKLE) — Sickle cell disease smear: sickled erythrocytes, target cells and Howell-Jolly bodies (functional asplenia) — hydroxyurea; vaccinate and penicillin prophylaxis.… https://thecodexes.com/image-bank/plates/SMEAR-SPHEROCYTES/ https://thecodexes.com/assets/MED-38905cf9f3e31882d262/original.png Spherocytes blood smear Spherocytes blood smear (SMEAR-SPHEROCYTES) — Spherocytes: small dense cells without central pallor — hereditary spherocytosis (osmotic fragility/EMA binding, Coombs negative) versus warm AIHA… https://thecodexes.com/image-bank/plates/SOC-EOL-07/ https://thecodexes.com/image-bank/plates/SOUND-CARD-01/ https://thecodexes.com/image-bank/plates/SOUND-RESP-01/ https://thecodexes.com/image-bank/plates/US-B11-028b/ https://thecodexes.com/assets/MED-6c0c949c0c93d6f51dd8/original.jpg T-shaped intrauterine device correctly positioned in the fundal endometrial cavity T-shaped intrauterine device correctly positioned in the fundal endometrial cavity (US-B11-028b) — Distinguish IUD type when interpreting bleeding: copper IUDs can increase menstrual bleeding… https://thecodexes.com/image-bank/plates/US-B11-042/ https://thecodexes.com/assets/MED-234adb41dbcf17655759/original.jpg Absent or markedly decreased color Doppler flow to the affected testis with an… Absent or markedly decreased color Doppler flow to the affected testis with an… (US-B11-042) — Abrupt scrotal pain + absent cremasteric reflex + high transverse testis → torsion → immediate… https://thecodexes.com/image-bank/plates/US-E1-038/ https://thecodexes.com/assets/MED-2fabfbd8641e77e1ee51/original.jpg Transvaginal ultrasonography, sagittal uterus, thin homogeneous endometrial stripe… Transvaginal ultrasonography, sagittal uterus, thin homogeneous endometrial stripe… (US-E1-038) — Postmenopausal bleeding needs prompt evaluation. Current ACOG guidance recommends transvaginal… https://thecodexes.com/image-bank/plates/US-E1-185/ https://thecodexes.com/assets/MED-c95c5036462521fe7635/original.jpg Polycystic ovarian morphology with more than 20 small peripheral follicles per ovary… Polycystic ovarian morphology with more than 20 small peripheral follicles per ovary… (US-E1-185) — Oligomenorrhea + hyperandrogenism → 2-hour 75-g oral glucose tolerance test, not fasting glucose… https://thecodexes.com/image-bank/plates/US-E2-011a/ https://thecodexes.com/assets/MED-3ecf26f2f5cef773eada/original.jpg Enlarged ovary with 20 or more small peripheral follicles (string-of-pearls pattern) Enlarged ovary with 20 or more small peripheral follicles (string-of-pearls pattern) (US-E2-011a) — PCOS without pregnancy desire → combined oral contraceptive first; screen glucose and lipids.… https://thecodexes.com/image-bank/plates/US-E2-011b/ https://thecodexes.com/assets/MED-22fd377567a4a9e42099/original.jpg Ovary with 20 or more peripheral antral follicles in polycystic ovarian morphology Ovary with 20 or more peripheral antral follicles in polycystic ovarian morphology (US-E2-011b) — Anovulatory PCOS, patent tubes, normal semen analysis → letrozole first. Exception: letrozole… https://thecodexes.com/image-bank/plates/US-E2-202/ https://thecodexes.com/assets/MED-cb04511e034c01ece0ab/original.jpg Transvaginal sagittal uterus with thin homogeneous endometrial stripe measuring 3 mm… Transvaginal sagittal uterus with thin homogeneous endometrial stripe measuring 3 mm… (US-E2-202) — Systemic estrogen with an intact uterus generally requires endometrial protection with a… https://thecodexes.com/image-bank/plates/US-E2-238/ https://thecodexes.com/assets/MED-5e326fc925ead6d3977d/original.png Transvaginal ultrasound of a well-circumscribed heterogeneous hypoechoic intramural… Transvaginal ultrasound of a well-circumscribed heterogeneous hypoechoic intramural… (US-E2-238) — Initial bleeding flare, then amenorrhea, hot flashes, low estradiol, low FSH/LH, and fibroid… https://thecodexes.com/image-bank/plates/US-ECTOPIC/ https://thecodexes.com/assets/MED-2a753d5b6b89375bcca8/original.png Ectopic pregnancy ultrasound Ectopic pregnancy ultrasound (US-ECTOPIC) — An empty uterus with elevated hCG raises concern for ectopic pregnancy but is not diagnostic alone. Combine symptoms, serial hCG, and transvaginal… https://thecodexes.com/image-bank/plates/US-ENDOMETRIOMA-GROUND-GLASS/ https://thecodexes.com/assets/MED-1153be0c5e76662c9581/original.png Ovarian endometrioma — ground-glass ultrasound Ovarian endometrioma — ground-glass ultrasound (US-ENDOMETRIOMA-GROUND-GLASS) — The cyst contents have fine, uniform echoes rather than the simple black fluid of a physiologic cyst. — Free USMLE®… https://thecodexes.com/image-bank/plates/US-GALLSTONES/ https://thecodexes.com/assets/MED-191a448171940d489edb/original.jpg Acute cholecystitis ultrasound Acute cholecystitis ultrasound (US-GALLSTONES) — Acute cholecystitis on ultrasound: stones with acoustic shadowing, wall >3 mm, pericholecystic fluid, sonographic Murphy sign. — Free USMLE® Step 2… https://thecodexes.com/image-bank/plates/US-HYDRONEPHROSIS/ https://thecodexes.com/assets/MED-87cfddae352cffb83cd8/original.png Hydronephrosis ultrasound Hydronephrosis ultrasound (US-HYDRONEPHROSIS) — Hydronephrosis indicates collecting-system dilation but does not alone establish obstructive AKI. Assess the obstruction level: catheterize for… https://thecodexes.com/image-bank/plates/US-MOLAR/ https://thecodexes.com/assets/MED-c4230497d2745da7a4e7/original.jpg Hydatidiform mole ultrasound Hydatidiform mole ultrasound (US-MOLAR) — Complete mole: 'snowstorm' uterus with no fetal parts, β-hCG far above dates, theca-lutein cysts — suction curettage, then weekly β-hCG and contraception.… https://thecodexes.com/image-bank/plates/US-OVARIAN-TORSION/ https://thecodexes.com/assets/MED-3cf0a8461165c8a7203d/original.jpg Ovarian torsion on ultrasound Ovarian torsion on ultrasound (US-OVARIAN-TORSION) — Suspected ovarian torsion is an urgent surgical diagnosis. Ultrasound can support it with an enlarged ovary and abnormal or absent flow, but… https://thecodexes.com/image-bank/plates/VIDEO-B07-029/ https://thecodexes.com/image-bank/plates/VIDEO-B08-018/ https://thecodexes.com/image-bank/plates/XR-ANKYLOSING/ https://thecodexes.com/assets/MED-d1b5968fee409bbc6562/original.png Ankylosing spondylitis Ankylosing spondylitis (XR-ANKYLOSING) — Ankylosing spondylitis: bilateral sacroiliitis progressing to a bamboo spine — HLA-B27; NSAIDs first, then TNF inhibitors. — Free USMLE® Step 2 CK ImageBank… https://thecodexes.com/image-bank/plates/XR-B09-011/ https://thecodexes.com/assets/MED-d5fb6773d632e245d17b/original.jpg Frog-leg lateral radiograph showing posterior-inferior displacement of the femoral… Frog-leg lateral radiograph showing posterior-inferior displacement of the femoral… (XR-B09-011) — Obese adolescent plus hip/knee pain plus obligatory external rotation with flexion -> slipped… https://thecodexes.com/image-bank/plates/XR-B09-018/ https://thecodexes.com/assets/MED-69ac76e3472654e05ccb/original.jpg Distal femoral metaphyseal mixed lytic-sclerotic lesion with sunburst periosteal… Distal femoral metaphyseal mixed lytic-sclerotic lesion with sunburst periosteal… (XR-B09-018) — Adolescent + localized metaphyseal osteoid-producing sarcoma → neoadjuvant chemotherapy, then wide… https://thecodexes.com/image-bank/plates/XR-B09-023/ https://thecodexes.com/assets/MED-497562c5868fb2215d68/original.jpg AP lumbar spine radiograph showing bamboo spine: thin, vertical marginal… AP lumbar spine radiograph showing bamboo spine: thin, vertical marginal… (XR-B09-023) — Young adult + inflammatory back pain + uveitis + syndesmophytes → enthesitis with reactive new bone… https://thecodexes.com/image-bank/plates/XR-B09-024/ https://thecodexes.com/assets/MED-861678b2f4100b7bba18/original.jpg AP shoulder radiograph of posterior dislocation showing lightbulb sign of internally… AP shoulder radiograph of posterior dislocation showing lightbulb sign of internally… (XR-B09-024) — Seizure or electrocution + arm locked in internal rotation → posterior dislocation; get axillary… https://thecodexes.com/image-bank/plates/XR-B09-038/ https://thecodexes.com/assets/MED-bbc34306ab25269f69e3/original.jpg AP knee radiograph showing asymmetric medial compartment joint space narrowing,… AP knee radiograph showing asymmetric medial compartment joint space narrowing,… (XR-B09-038) — Joint pain that worsens with activity and improves with rest, with brief morning stiffness, normal… https://thecodexes.com/image-bank/plates/XR-B10-002/ https://thecodexes.com/assets/MED-6277121253d0386357b1/original.jpg Voiding cystourethrogram showing grade III vesicoureteral reflux with bilateral… Voiding cystourethrogram showing grade III vesicoureteral reflux with bilateral… (XR-B10-002) — Febrile UTI + moderate or higher vesicoureteral reflux in a young child → recurrent pyelonephritis →… https://thecodexes.com/image-bank/plates/XR-B11-045/ https://thecodexes.com/assets/MED-588897ae8d9ed56f953f/original.jpg Metaphyseal cupping, fraying, and widening of the distal radius and ulna with a… Metaphyseal cupping, fraying, and widening of the distal radius and ulna with a… (XR-B11-045) — Exclusively breastfed infant + bowing, rosary, low 25-hydroxyvitamin D, high PTH and alkaline… https://thecodexes.com/image-bank/plates/XR-CHILD-ABUSE-META/ https://thecodexes.com/assets/MED-2f3c2ed9809ccdf3a072/original.jpg Metaphyseal corner fracture Metaphyseal corner fracture (XR-CHILD-ABUSE-META) — Metaphyseal corner fractures and posterior rib fractures in an infant are highly specific for abuse — skeletal survey under 2 years, report… https://thecodexes.com/image-bank/plates/XR-COLLES/ https://thecodexes.com/assets/MED-25c5ec0cc0a1375517f5/original.jpg Colles fracture Colles fracture (XR-COLLES) — Colles fracture: dorsally angulated distal radius after a fall on the outstretched hand — closed reduction and cast; check the median nerve. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/XR-E1-034/ https://thecodexes.com/assets/MED-4dc88c69960f0a76ba69/original.jpg Oblique radiograph of the hand showing a fifth metacarpal neck fracture with 35… Oblique radiograph of the hand showing a fifth metacarpal neck fracture with 35… (XR-E1-034) — Laceration over a knuckle after punching a mouth → irrigate, leave open, give amoxicillin-clavulanate.… https://thecodexes.com/image-bank/plates/XR-E2-030/ https://thecodexes.com/assets/MED-d9c3a2a5a837a1da36d7/original.jpg Abdominal radiograph showing pneumobilia, an ectopic calcified gallstone in the right… Abdominal radiograph showing pneumobilia, an ectopic calcified gallstone in the right… (XR-E2-030) — Small bowel obstruction + biliary air + ectopic calcified density → gallstone ileus; treat with… https://thecodexes.com/image-bank/plates/XR-GOUT-TOPHI/ https://thecodexes.com/assets/MED-5e60af757a5d642e5986/original.jpg Gout podagra Gout podagra (XR-GOUT-TOPHI) — Podagra is an acutely inflamed first MTP joint; monosodium urate crystals are needle-shaped and negatively birefringent. Treat the flare with an NSAID, colchicine, or… https://thecodexes.com/image-bank/plates/XR-HIP-FRACTURE/ https://thecodexes.com/assets/MED-822873e0907251996d0a/original.jpg Femoral neck fracture Femoral neck fracture (XR-HIP-FRACTURE) — Displaced femoral neck fracture: shortened, externally rotated leg — hemiarthroplasty/THA in the elderly because the femoral head's blood supply is lost.… https://thecodexes.com/image-bank/plates/XR-INTUSSUSCEPTION-US/ https://thecodexes.com/assets/MED-73385fa49a85186e4cd6/original.png Intussusception target sign Intussusception target sign (XR-INTUSSUSCEPTION-US) — Intussusception: target sign on ultrasound — air or hydrostatic enema is both diagnostic and therapeutic; surgery if peritonitis or failed… https://thecodexes.com/image-bank/plates/XR-OA-VS-RA/ https://thecodexes.com/assets/MED-052b4ef8a555a539b13a/original.jpg Rheumatoid arthritis hand Rheumatoid arthritis hand (XR-OA-VS-RA) — Rheumatoid hand: MCP/PIP erosions, periarticular osteopenia, ulnar deviation — contrast with osteoarthritis (DIP, osteophytes). — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/XR-PAGET/ https://thecodexes.com/assets/MED-440887cb864487d9cc38/original.jpg Paget disease bone Paget disease bone (XR-PAGET) — Paget disease: coarsened trabeculae and cortical thickening with an isolated raised alkaline phosphatase — bisphosphonate; watch for osteosarcoma and high-output… https://thecodexes.com/image-bank/plates/XR-PYLORIC-US/ https://thecodexes.com/assets/MED-6475823fb650c4392f0c/original.jpg Pyloric stenosis ultrasound Pyloric stenosis ultrasound (XR-PYLORIC-US) — Pyloric stenosis: muscle >3–4 mm thick and channel >15–17 mm — correct hypochloremic hypokalemic alkalosis before pyloromyotomy. — Free USMLE® Step 2 CK… https://thecodexes.com/image-bank/plates/XR-SALTER-HARRIS/ https://thecodexes.com/assets/MED-fd033cd1fdcc8c2d1bed/original.jpg Salter Harris fracture Salter Harris fracture (XR-SALTER-HARRIS) — Salter-Harris II: fracture through the physis exiting the metaphysis — the commonest type; closed reduction and cast. — Free USMLE® Step 2 CK ImageBank… https://thecodexes.com/image-bank/plates/XR-SCAPHOID/ https://thecodexes.com/assets/MED-1262662fe2504b462b43/original.jpg Scaphoid fracture Scaphoid fracture (XR-SCAPHOID) — Scaphoid fracture: snuffbox tenderness with a normal initial film still gets a thumb spica and repeat imaging — proximal-pole nonunion and avascular necrosis.… https://thecodexes.com/image-bank/plates/XR-SCFE/ https://thecodexes.com/assets/MED-b7912126927f0befb0ea/original.jpg Slipped capital femoral epiphysis Slipped capital femoral epiphysis (XR-SCFE) — Slipped capital femoral epiphysis: 'ice cream falling off the cone' on frog-leg lateral — non-weight-bearing and in-situ pinning; obese adolescents.… https://thecodexes.com/image-bank/plates/XR-SHOULDER-DISL/ https://thecodexes.com/assets/MED-0191526d90af7d5c1a1b/original.png Anterior shoulder dislocation Anterior shoulder dislocation (XR-SHOULDER-DISL) — Anterior shoulder dislocation: humeral head sits below and medial to the glenoid — check axillary nerve sensation before and after reduction.…