Cases & Concepts Step 1: Basic Science Review

402 Pages·2009·3.778 MB·English

by  Aaron B. Caughey

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Cases and Concepts Step 1:
Basic Science Review
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Cases and Concepts Step 1:
Basic Science Review
Aaron B.Caughey,MD,MPP,MPH,PhD Jillian S.Main
Associate Professor Class of 2009
Fellowship Program Director Chicago Medical School
Division of Maternal-Fetal Medicine Chicago,Illinois
Department of Obstetrics,Gynecology,and Reproductive Services
University of California at San Francisco Judith Neugroschl,MD
San Francisco,California Assistant Professor of Psychiatry
Director of Medical Student Education in Psychiatry
Paul Baum,MD Mount Sinai School of Medicine
Assistant Adjunct Professor of Medicine New York,New York
Division of Experimental Medicine
UCSF School of Medicine Laetitia Poisson de Souzy,MD
San Francisco,California Resident
Department of Obstetrics and Gynecology
Christie del Castillo-Hegyi,MD University of California at San Francisco
Attending Emergency Physician San Francisco,California
Presbyterian Hospital
University of New Mexico Teresa Sparks
Albuquerque,New Mexico Class of 2009
UCSF School of Medicine
Monica Ghandi,MD San Francisco,California
Assistant Professor
Division of Infectious Diseases Annie Tan,MD
Department of Medicine Clinical Fellow
University of California at San Francisco Department of Obstetrics and Gynecology
San Francisco,California University of Minnesota
Minneapolis,Minnesota
Larissa R.Graff,PharmD
Assistant Clinical Professor Susan H.Tran,MD
Department of Clinical Pharmacy Fellow in Maternal-Fetal Medicine and Clinical Genetics
School of Pharmacy Department of Obstetrics,Gynecology,
University of California at San Francisco and Reproductive Sciences
Clinical Pharmacist—Hematology/Oncology University of California at San Francisco
University of California at San Francisco Medical Center San Francisco,California
San Francisco,California
Juan E.Vargas,MD
C.Bradley Hare,MD Assistant Clinical Professor
Assistant Professor University of California at San Francisco School of Medicine
Division of Infectious Diseases San Francisco,California
Department of Medicine
University of California at San Francisco Jed T.Wolpaw,M.Ed
San Francisco,California Class of 2010
UCSF School of Medicine
Jennifer Hoblyn,MB,MMSci,MRCPsych,MPH San Francisco,California
VA Palo Alto Health Care System
Palo Alto,California Katherine Y.Yang,PharmD,MPH
Department of Psychiatry and Behavioral Sciences Assistant Clinical Professor
Stanford University School of Medicine Department of Clinical Pharmacy
Stanford,California School of Pharmacy
University of California at San Francisco
Jonathan Z.Li,MD Infectious Diseases Clinical Pharmacist
Clinical and Research Fellow University of California at San Francisco Medical Center
Division of Infectious Disease San Francisco,California
Brigham and Women’s Hospital
Massachusetts General Hospital
Boston,Massachusetts Series Editor:Aaron B.Caughey,MD,MPP,MPH,PhD
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First Edition
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All rights reserved.This book is protected by copyright.No part of this book may be reproduced or transmitted
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9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Cases and Concepts Step 1:Basic Science Review / Aaron B.Caughey ...[et al.].
p.;cm.
Includes index.
ISBN-13:978-0-7817-9391-9
ISBN-10:0-7817-9391-2
1. Medicine—Case studies. 2. Medical sciences—Case studies.
I. Caughey,Aaron B. II. Title:Basic science review.
[DNLM: 1. Clinical Medicine—methods—Case Reports. 2. Clinical
Medicine—methods—Examination Questions. WB 293 C338 2010]
RC66.C365 2010
610—dc22
2008044380
DISCLAIMER
Care has been taken to confirm the accuracy of the information present and to describe generally accepted practices.
However,the authors,editors,and publisher are not responsible for errors or omissions or for any consequences from
application of the information in this book and make no warranty,expressed or implied,with respect to the currency,
completeness,or accuracy of the contents of the publication.Application of this information in a particular situation
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PREFACE
The first 2 years of medical school are a demanding time for This series covers all the essential material needed in the basic
medical students.Whether the school follows a traditional science courses.Where possible,the books are organized in an
curriculum or one that is case based,every student is expected organ-based system.Clinical cases lead off and are the basis for
to learn and be able to apply basic science information in a discussion of the basic science content.A list of thought ques-
clinical situation. tions follows the case presentation.These questions are designed
Medical schools are increasingly using clinical presentations as to challenge the reader to begin to think about how basic sci-
the background to teach the basic sciences.Case-based learning ence topics apply to real-life clinical situations.The answers to
has become more common at many medical schools,as it offers these questions are integrated within the basic science review
a way to catalogue the multitude of symptoms,syndromes,and and discussion that follows.This offers a clinical framework
diseases in medicine. from which to understand the basic content.
Cases and Concepts is a new series by Lippincott Williams & The discussion section is followed by a high-yield Thumbnail
Wilkins designed to provide students with a textbook to study the table and a Key Points box that highlight and summarize the
basic science topics combined with clinical data.This method of essentialinformation presented in the discussion.The cases also
learning is also the way to prepare for the clinical case format of include two to four multiple-choice questionsthat allow readers to
USMLE questions.The books in this series will make the basic check their knowledge of that topic.Many of the answer explana-
science topics not only more interesting but also more meaning- tions provide an opportunity for further discussion by delving into
ful and memorable.Students will be learning not only the why of more depth in related areas.Fullanswer explanations can be found
a principle but also how it might commonly be seen in practice. at the endof the book.
The books in the Cases and Concepts series feature a com- This series was designed to provide comprehensive contentin
prehensive collection of cases that are designed to introduce one a concise and templated format for ease in learning.Adedicated
or more basic science topics.Through these cases,students gain attempt was made to include sufficient art,tables,and clinical
an understanding of the coursework as they learn to: treatment information,all while keeping the books from becoming
too lengthy.We know you have much to read and that what you
• Think through the cases
want is high-yield,vital facts.
• Look for classic presentations of most common diseases
Lippincott Williams & Wilkins and the authors wish you suc-
and syndromes
cess in your studies and in your future medical career.Please
• Integrate the basic science content with clinical application
feel free to offer us any comments or suggestions on these books
• Prepare for course exams and Step 1 USMLE
at www.lww.com.
• Be prepared for clinical rotations
v
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CONTENTS
Preface v Case 1-25.Coccidioidomycosis and the Endemic
Abbreviations xi Mycoses 68
Normal Ranges of Laboratory Values xvii
Case 1-26.Plasmodium 71
PART I: MICROBIOLOGY PART II: IMMUNOLOGY
Case 1-1. StaphylococcusAureus 2 Case 2-1. Cell-Mediated Immunity 76
Case 1-2. Streptococcus Pyogenesand the Other Case 2-2. Humoral Immunity and Autoimmune
β-hemolytic Streptococci 5 Disease 83
Case 1-3. α-Hemolytic Streptococci 8 Case 2-3. Innate Immunity and the Complement
System 87
Case 1-4. Enterococci 12
Case 2-4. Immunodeficiency 92
Case 1-5. Nocardiaand an Overview of the
Gram-Positive Rods 14
PART III: PHARMACOLOGY
Case 1-6. Clostridium Difficile 17 Case 3-1. Clinical Pharmacokinetics 98
Case 1-7. Neisseria Meningitidis 19 Case 3-2. Nitrates 103
Case 1-8. Gram-Negative Rods that Cause Case 3-3. Beta-Blockers 105
Gastrointestinal Infections 22
Case 3-4. Calcium Channel Blockers 108
Case 1-9. Pseudomonas Aeruginosa 25
Case 3-5. Diuretics 110
Case 1-10.Salmonella Typhi 28
Case 3-6. Angiotensin-Converting
Case 1-11.Mycobacterium Tuberculosis 30 Enzyme Inhibitors 112
Case 1-12.Nontuberculous Mycobacteria 33 Case 3-7. Angiotensin Receptor Blockers 114
Case 1-13.Mycoplasma 37 Case 3-8. Anticoagulant Agents 116
Case 1-14.Treponema Pallidum 40 Case 3-9. Opioids 119
Case 1-15.Herpes Simplex Virus 42 Case 3-10.Anticonvulsants 122
Case 1-16.Cytomegalovirus 45 Case 3-11.Agents Used for Anxiety Disorders 125
Case 1-17.Human Immunodeficiency Virus 47 Case 3-12.Agents Used for Depression 127
Case 1-18.West Nile Virus 50 Case 3-13.Agents for Schizophrenia 129
Case 1-19.Hepatitis A Virus 53 Case 3-14.Agents for Hyperthyroidism 131
Case 1-20.Hepatitis B Virus 55 Case 3-15.Agents for Diabetes: Insulin 133
Case 1-21.Influenza Virus 58 Case 3-16.Agents for Diabetes: Oral Agents 135
Case 1-22.Aspergillus Fumigatus 61 Case 3-17.Agents for Hyperlipidemia 138
Case 1-23.Cryptococcus Neoformans 64 Case 3-18.Agents for Asthma 140
Case 1-24.Candida Albicans 66 Case 3-19.Oral Contraception 143
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Contents
Case 3-20.Agents for Peptic Ulcer Disease 145 Case 5-3. X-Linked Dominant Inheritance 222
Case 3-21.Agents for Gastroesophageal Case 5-4. Mitochondrial Inheritance 224
Reflux Disease 147
Case 5-5. Variable Penetrance 227
Case 3-22.Penicillins 149
Case 5-6. Chromosome Structure 230
Case 3-23.Cephalosporins 151
Case 5-7. Sex Chromosomes 232
Case 3-24.Macrolides 154
Case 5-8. Genomic Imprinting 234
Case 3-25.Tetracyclines 156
Case 5-9. Cell Cycle 237
Case 3-26.Fluoroquinolones and Trimethoprim-
Sulfamethoxazole 158 PART VI: EMBRYOLOGY
Case 6-1. Embryonic Development 240
Case 3-27.Aminoglycosides 161
Case 6-2. Teratogens 243
Case 3-28.Vancomycin 163
Case 6-3. Neural Tube Development 246
Case 3-29.Antianaerobic Agents 165
Case 6-4. Branchial Arch Anomalies 249
Case 3-30.Antiviral Agents for Herpes Viruses 167
Case 3-31.Antifungal Agents 169 PART VII: BEHAVIORAL SCIENCE
Case 3-32.Anthracyclines 171 Case 7-1. Developmental Milestones 254
Case 3-33.Alkylating Agents 173 Case 7-2. Depression in Pregnancy 257
Case 3-34.Antimetabolites 175 Case 7-3. Psychopharmacology 259
Case 3-35.Vinca Alkaloids 177 Case 7-4. Learning Theory 262
Case 3-36.Taxanes 179 Case 7-5. Defense Mechanisms 265
Case 7-6. Suicide Attempt 268
PART IV: BIOCHEMISTRY
Case 4-1. Glycolysis 182 Case 7-7. Abuse 271
Case 4-2. Glycogen Synthesis and Degradation 184 Case 7-8. Capacity 273
Case 4-3. Oxidative Phosphorylation 187 Case 7-9. Eating Disorders 276
Case 4-4. Fatty Acid Metabolism 189 Case 7-10.Obesity 279
Case 4-5. Steroid Biosynthesis 192
PART VIII: NEUROSCIENCE,PSYCHIATRY,
PSYCHOPHARMACOLOGY,
Case 4-6. Cholesterol Synthesis 195
AND PSYCHOPATHOLOGY
Case 4-7. Cholesterol and Lipid Metabolism 198
Case 8-1. Depression 284
Case 4-8. Homocystinuria 201
Case 8-2. Bipolar Disorder: Etiology
Case 4-9. Phenylketonuria 203 and Epidemiology 287
Case 4-10.The Urea Cycle 205 Case 8-3. Anxiety Disorders 290
Case 4-11.Vitamin Function 209 Case 8-4. Obsessive-Compulsive Disorder 293
PART V: GENETICS Case 8-5. Delirium 296
Case 5-1. Autosomal Dominant Inheritance 216 Case 8-6. Dementia 299
Case 5-2. Autosomal Recessive Inheritance 219 Case 8-7. Personality Disorders 303
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